Provider Demographics
NPI:1457625725
Name:CARACCIA, DEREK MICHAEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:MICHAEL
Last Name:CARACCIA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CHESTER RD STE 25
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05156-2953
Mailing Address - Country:US
Mailing Address - Phone:802-885-5311
Mailing Address - Fax:
Practice Address - Street 1:2 CHESTER RD STE 25
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VT
Practice Address - Zip Code:05156-2953
Practice Address - Country:US
Practice Address - Phone:802-885-5311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0082898183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist