Provider Demographics
NPI:1225031800
Name:HOTEL PHARMACY INC
Entity Type:Organization
Organization Name:HOTEL PHARMACY INC
Other - Org Name:THE HOTEL PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GIAMARTINO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:802-254-2303
Mailing Address - Street 1:20 ELLIOT ST
Mailing Address - Street 2:NO 1
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-3216
Mailing Address - Country:US
Mailing Address - Phone:802-254-2303
Mailing Address - Fax:802-257-0023
Practice Address - Street 1:20 ELLIOT ST
Practice Address - Street 2:NO 1
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-3216
Practice Address - Country:US
Practice Address - Phone:802-254-2303
Practice Address - Fax:802-257-0023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VT03800005653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02848511Medicaid
VT0007143Medicaid
4700565OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY02848511Medicaid