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General NPI Number Information
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NPI Number | 1497807069
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Entity Type | Organization
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Legal Business Name | VINCENTS REXALL DRUGS INC
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 80 SOUTH MAIN ST
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City | WATERBURY
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State | VT
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Zip | 05676-0059
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Country | US
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Telephone | 802-244-8458
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Fax | 802-244-1108
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Provider Business Mailing Address
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Address Line | PO BOX 59
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City | WATERBURY
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State | VT
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Zip | 05676-0059
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Country | US
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Telephone | 802-244-8458
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Fax | 802-244-1108
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOHN WILLIAM VINCENT
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Credential | REGISTERED PHARMACIS
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Telephone | 802-244-8458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 0380001098
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License Number State | VT
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