Provider Demographics
NPI:1457455420
Name:VERMONT FAMILY PHARMACY INC
Entity Type:Organization
Organization Name:VERMONT FAMILY PHARMACY INC
Other - Org Name:VERMONT FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:
Authorized Official - Last Name:VEZINA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:802-658-9664
Mailing Address - Street 1:1219 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05408-2747
Mailing Address - Country:US
Mailing Address - Phone:802-658-9664
Mailing Address - Fax:802-658-3172
Practice Address - Street 1:1219 NORTH AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05408-2747
Practice Address - Country:US
Practice Address - Phone:802-658-9664
Practice Address - Fax:802-658-3172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VT03800023173336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009629Medicaid
2101400OtherPK
VT4835850001Medicare NSC