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General NPI Number Information
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NPI Number | 1477250264
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Entity Type | Individual
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Provider Name | JUSTIN LACHANCE PHARMD
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Gender | Male
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Dates
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Enumeration Date | 02/13/2023
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Last Update Date | 02/13/2023
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Provider Practice Location Address
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Address Line | 30 SHELBURNE SHOPPING PARK
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City | SHELBURNE
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State | VT
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Zip | 05482-7488
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Country | US
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Telephone | 802-985-2610
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Fax |
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Provider Business Mailing Address
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Address Line | 84 CHAMBERLAIN ST
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City | ROCHESTER
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State | NH
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Zip | 03867-3301
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Country | US
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Telephone | 603-973-3401
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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 | 0330134920
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License Number State | VT
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