MEDICARE: PRICE CHOPPER OPERATING CO OF VERMONT INC

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	3336S0011X	Specialty Pharmacy
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	0380003328	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2101706	OTHER		PK

General Provider Information

NPI Number	:	1518070986
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRICE CHOPPER OPERATING CO OF VERMONT INC

Provider Business Mailing Address
First Line	:	461 NOTT ST
Second Line	:	MB#202
City	:	SCHENECTADY
State	:	NY
Zip	:	12308-1812
Country	:	US
Telephone Number	:	518-379-1618
Fax Number	:	518-356-6978

Provider Business Practice Location Address
First Line	:	90 CENTER RD
Second Line	:
City	:	ESSEX JUNCTION
State	:	VT
Zip	:	05452-2658
Country	:	US
Telephone Number	:	802-879-4155
Fax Number	:	802-878-7448

Authorized Official
Title or Position	:	VP OF PHARMACY
Name	:	SCOTT GUISINGER
Credential	:
Telephone Number	:	518-379-2409

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	05/19/2026

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