Provider Demographics
NPI:1073199345
Name:UNIVERSITY OF VERMONT MEDICAL CENTER INC
Entity Type:Organization
Organization Name:UNIVERSITY OF VERMONT MEDICAL CENTER INC
Other - Org Name:UNIVERSITY OF VERMONT MEDICAL CENTER OUTPATIENT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:ELKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-847-1882
Mailing Address - Street 1:111 COLCHESTER AVE
Mailing Address - Street 2:C/O MARK DIPARLO
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-1473
Mailing Address - Country:US
Mailing Address - Phone:802-847-2622
Mailing Address - Fax:
Practice Address - Street 1:75 HOLLY CT
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-7247
Practice Address - Country:US
Practice Address - Phone:802-847-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-18
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy