MEDICARE: AVA PETERS PHARMD

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	033.0135448	VT

General Provider Information

NPI Number	:	1952131310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVA PETERS PHARMD

Provider Business Mailing Address
First Line	:	217 DORSET ST
Second Line	:
City	:	SOUTH BURLINGTON
State	:	VT
Zip	:	05403-6208
Country	:	US
Telephone Number	:	860-371-9627
Fax Number	:

Provider Business Practice Location Address
First Line	:	217 DORSET ST
Second Line	:
City	:	SOUTH BURLINGTON
State	:	VT
Zip	:	05403-6208
Country	:	US
Telephone Number	:	802-863-1378
Fax Number	:

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

Provider Enumeration Date	:	08/01/2024
Last Update Date	:	07/23/2025

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