Provider Demographics
NPI:1407867054
Name:UNIVERSITY OF VERMONT MEDICAL CENTER INC
Entity Type:Organization
Organization Name:UNIVERSITY OF VERMONT MEDICAL CENTER INC
Other - Org Name:UVM MEDICAL CENTER OUTPATIENT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MGR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:DIPARLO
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARM
Authorized Official - Phone:802-847-2622
Mailing Address - Street 1:792 COLLEGE PKWY
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-3052
Mailing Address - Country:US
Mailing Address - Phone:802-847-7461
Mailing Address - Fax:802-847-7462
Practice Address - Street 1:792 COLLEGE PKWY
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-3052
Practice Address - Country:US
Practice Address - Phone:802-847-7461
Practice Address - Fax:802-847-7462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
VT0300032933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1012209Medicaid
2101484OtherPK
2101484OtherPK