Provider Demographics
NPI:1497807069
Name:VINCENTS REXALL DRUGS INC
Entity Type:Organization
Organization Name:VINCENTS REXALL DRUGS INC
Other - Org Name:VINCENTS DRUG AND VARIETY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED PHARMACIS
Authorized Official - Phone:802-244-8458
Mailing Address - Street 1:PO BOX 59
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05676-0059
Mailing Address - Country:US
Mailing Address - Phone:802-244-8458
Mailing Address - Fax:802-244-1108
Practice Address - Street 1:80 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:VT
Practice Address - Zip Code:05676-0059
Practice Address - Country:US
Practice Address - Phone:802-244-8458
Practice Address - Fax:802-244-1108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0380001098333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4701098OtherNABP
VT0007110Medicaid
4701098OtherNABP