Provider Demographics
NPI:1497939110
Name:EQUINOX COMPOUNDING PHARMACY
Entity Type:Organization
Organization Name:EQUINOX COMPOUNDING PHARMACY
Other - Org Name:EQUINOX COMPOUNDING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:O NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-442-5602
Mailing Address - Street 1:PO BOX 737
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-0737
Mailing Address - Country:US
Mailing Address - Phone:802-442-5602
Mailing Address - Fax:802-442-8023
Practice Address - Street 1:34B WAYS LN
Practice Address - Street 2:
Practice Address - City:MANCHESTER CENTER
Practice Address - State:VT
Practice Address - Zip Code:05255-9231
Practice Address - Country:US
Practice Address - Phone:802-367-1096
Practice Address - Fax:802-367-1098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT03800033893336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1014827Medicaid
2101743OtherPK