MEDICARE: ERIC JOHN SHUBERT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	033-0003372	VT

General Provider Information

NPI Number	:	1235261140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC JOHN SHUBERT

Provider Business Mailing Address
First Line	:	1283 CASE ST
Second Line	:
City	:	MIDDLEBURY
State	:	VT
Zip	:	05753-9181
Country	:	US
Telephone Number	:	802-388-4582
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 PORTER DR
Second Line	:
City	:	MIDDLEBURY
State	:	VT
Zip	:	05753-8423
Country	:	US
Telephone Number	:	802-388-4711
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	07/08/2007

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