MEDICARE: THE MEDICAL STORE, LTD.

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	332B00000X	Durable Medical Equipment & Medical Supplies

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

General Provider Information

NPI Number	:	1669429072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE MEDICAL STORE, LTD.

Provider Business Mailing Address
First Line	:	1225 AIRPORT PKWY
Second Line	:
City	:	SOUTH BURLINGTON
State	:	VT
Zip	:	05403-5805
Country	:	US
Telephone Number	:	802-864-0908
Fax Number	:	802-862-6482

Provider Business Practice Location Address
First Line	:	1225 AIRPORT PKWY
Second Line	:
City	:	SOUTH BURLINGTON
State	:	VT
Zip	:	05403-5805
Country	:	US
Telephone Number	:	802-864-0908
Fax Number	:	802-862-6482

Authorized Official
Title or Position	:	CEO
Name	:	MR. CHRISTOPHER JOHN HENRY
Credential	:
Telephone Number	:	802-864-0908

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	08/22/2020

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Directions to “THE MEDICAL STORE, LTD. ” Practice Location

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