Provider Demographics
NPI:1679667323
Name:THE MEDICAL STORE
Entity Type:Organization
Organization Name:THE MEDICAL STORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-864-0908
Mailing Address - Street 1:168 AMES DRIVE NO 3
Mailing Address - Street 2:
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641
Mailing Address - Country:US
Mailing Address - Phone:802-476-3135
Mailing Address - Fax:802-479-5022
Practice Address - Street 1:168 AMES DRIVE NO 3
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641
Practice Address - Country:US
Practice Address - Phone:802-476-3135
Practice Address - Fax:802-479-5022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0274670002Medicare NSC