Provider Demographics
NPI:1497264899
Name:CHELSEA PHARMACY LLC
Entity Type:Organization
Organization Name:CHELSEA PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MAYUR
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-292-8200
Mailing Address - Street 1:356 VT-110
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:VT
Mailing Address - Zip Code:05038
Mailing Address - Country:US
Mailing Address - Phone:802-685-2100
Mailing Address - Fax:802-685-3499
Practice Address - Street 1:356 VT-110
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:VT
Practice Address - Zip Code:05038
Practice Address - Country:US
Practice Address - Phone:802-685-2100
Practice Address - Fax:802-685-3499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-28
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VT038.01291873336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2172455OtherPK