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General NPI Number Information
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NPI Number | 1215812961
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Entity Type | Organization
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Legal Business Name | DOG RIVER PHARMACY INC
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Dates
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Enumeration Date | 08/11/2025
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 14 DEPOT SQ STE 1
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City | NORTHFIELD
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State | VT
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Zip | 05663-6960
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Country | US
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Telephone | 802-485-4771
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Fax |
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Provider Business Mailing Address
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Address Line | 63 SYLVAN RDG
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City | RICHMOND
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State | VT
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Zip | 05477-1701
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Country | US
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Telephone | 774-266-4793
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KYLE MAXWELL
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Credential | PHARMD, RPH
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Telephone | 802-485-4771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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