Provider Demographics
NPI:1053078089
Name:REMILLARD, SEAN BILLINGS
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:BILLINGS
Last Name:REMILLARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 FLIGHT LINE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VT
Mailing Address - Zip Code:05454-9713
Mailing Address - Country:US
Mailing Address - Phone:802-881-1062
Mailing Address - Fax:
Practice Address - Street 1:600 BLAIR PARK RD
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-7586
Practice Address - Country:US
Practice Address - Phone:800-861-1903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0134596183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTFA0V820131740000OtherBLUECROSS BLUESHIELD