Provider Demographics
NPI:1629116918
Name:GIAMARTINO, MARY ELIZABETH (RPH)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELIZABETH
Last Name:GIAMARTINO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ELLIOT ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-3208
Mailing Address - Country:US
Mailing Address - Phone:802-254-2303
Mailing Address - Fax:802-257-0023
Practice Address - Street 1:20 ELLIOT ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-3208
Practice Address - Country:US
Practice Address - Phone:802-254-2303
Practice Address - Fax:802-257-0023
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0330002621183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0380000565OtherRETAIL PHARMACY LICENSE