Provider Demographics
NPI:1134184948
Name:PHARMACY HEALTH SERVICES INC
Entity type:Organization
Organization Name:PHARMACY HEALTH SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-893-5105
Mailing Address - Street 1:99 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-1595
Mailing Address - Country:US
Mailing Address - Phone:802-388-3784
Mailing Address - Fax:802-388-1720
Practice Address - Street 1:99 MAPLE ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-1595
Practice Address - Country:US
Practice Address - Phone:802-388-3784
Practice Address - Fax:802-388-1720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VT038.00033983336C0003X
VT03800033983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1002271Medicaid
2101425OtherPK
0363880003Medicare NSC