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General NPI Number Information
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NPI Number | 1124136502
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Entity Type | Organization
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Legal Business Name | MARTINS FOODS OF SOUTH BURLINGTON LLC
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Dates
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Enumeration Date | 08/27/2006
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 35 HANNAFORD DR
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City | RED HOOK
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State | NY
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Zip | 12571-1653
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Country | US
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Telephone | 845-758-9331
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Fax | 845-758-9322
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Provider Business Mailing Address
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Address Line | PO BOX 1000 MS 3000
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City | PORTLAND
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State | ME
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Zip | 04104-5005
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Country | US
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Telephone | 207-885-7454
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Fax | 704-645-6531
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Authorized Official
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Title or Position | PRESIDENT AND MANAGER
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Name | MICHAEL VAIL
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Credential |
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Telephone | 207-885-7454
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 026163
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License Number State | NY
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