Provider Demographics
NPI:1558039644
Name:MAXWELLS PHARMACY INC
Entity Type:Organization
Organization Name:MAXWELLS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ TREAS.
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-862-1562
Mailing Address - Street 1:242 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-8532
Mailing Address - Country:US
Mailing Address - Phone:802-862-1491
Mailing Address - Fax:802-865-2208
Practice Address - Street 1:242 PEARL ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8532
Practice Address - Country:US
Practice Address - Phone:802-862-1491
Practice Address - Fax:802-865-2208
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAXWELLS PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy