Provider Demographics
NPI:1619077468
Name:MC AVOY, JOHN W (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:W
Last Name:MC AVOY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:UNDERHILL
Mailing Address - State:VT
Mailing Address - Zip Code:05489
Mailing Address - Country:US
Mailing Address - Phone:802-899-4177
Mailing Address - Fax:
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
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033-0003065183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist