Provider Demographics
NPI:1619361482
Name:CALDERON, ANTHONY (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:CALDERON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 S JEFFERSON RD
Mailing Address - Street 2:UNIT 108
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7940
Mailing Address - Country:US
Mailing Address - Phone:646-294-1027
Mailing Address - Fax:
Practice Address - Street 1:144 S JEFFERSON RD
Practice Address - Street 2:UNIT 108
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7940
Practice Address - Country:US
Practice Address - Phone:646-294-1027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0330107388183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist