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NPI Code Detail

MEDICARE: STACY EMILY BRUYNS RPH

MEDICARE: STACY EMILY BRUYNS RPH
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
1183500000XPharmacist3338VT

General Provider Information

NPI Number : 1366754962
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY EMILY BRUYNS RPH
Provider Business Mailing Address
First Line : 3 RAYMOND DR
Second Line :
City : ESSEX JUNCTION
State : VT
Zip : 05452-3867
Country : US
Telephone Number : 802-872-9318
Fax Number :
Provider Business Practice Location Address
First Line : 82 PEARL ST
Second Line :
City : ESSEX JUNCTION
State : VT
Zip : 05452-3642
Country : US
Telephone Number : 802-878-5351
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2010
Last Update Date : 07/12/2010

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Directions to “ STACY EMILY BRUYNS RPH” Practice Location

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