=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184057382
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOLLY BEE PARTNERS DBA PUTNEY PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2013
-----------------------------------------------------
Last Update Date | 08/09/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4 KIMBALL HILL ROAD
-----------------------------------------------------
City | PUTNEY
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05346-0508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-387-4692
-----------------------------------------------------
Fax | 802-387-4131
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 508 4 KIMBALL HILL ROAD
-----------------------------------------------------
City | PUTNEY
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05346-0508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-387-4692
-----------------------------------------------------
Fax | 802-387-4131
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST/MANAGER
-----------------------------------------------------
Name | JAMES S HEAL
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 802-387-4692
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 0380094973
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------