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General NPI Number Information
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NPI Number | 1184395063
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Entity Type | Individual
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Provider Name | ALICIA BAUTISTA PHARMD
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Gender | Female
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Dates
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Enumeration Date | 09/21/2021
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Last Update Date | 09/21/2021
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Provider Practice Location Address
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Address Line | 52 MAIN ST
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City | WINDSOR
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State | VT
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Zip | 05089-1308
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Country | US
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Telephone | 802-674-2334
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Fax |
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Provider Business Mailing Address
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Address Line | 7 MULBERRY ST APT 4
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City | CLAREMONT
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State | NH
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Zip | 03743-2541
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Country | US
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Telephone | 518-932-9977
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 033.0134578
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License Number State | VT
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