Provider Demographics
NPI:1184798944
Name:MONTPELIER PHARMACY INC
Entity type:Organization
Organization Name:MONTPELIER PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPAOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:802-233-9440
Mailing Address - Street 1:69 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-2931
Mailing Address - Country:US
Mailing Address - Phone:802-223-4633
Mailing Address - Fax:
Practice Address - Street 1:69 MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-2931
Practice Address - Country:US
Practice Address - Phone:802-223-4633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VT038.00681503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2101738OtherPK
4704208OtherNCPDP PROVIDER IDENTIFICATION NUMBER
VT5871030001Medicare NSC