Provider Demographics
NPI:1750599122
Name:HUBBARD MACLAUCHLAN, ANDREA R (RPH)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:R
Last Name:HUBBARD MACLAUCHLAN
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 1:290 COLUMBIA DR
Mailing Address - Street 2:
Mailing Address - City:BOMOSEEN
Mailing Address - State:VT
Mailing Address - Zip Code:05732-9641
Mailing Address - Country:US
Mailing Address - Phone:802-273-3702
Mailing Address - Fax:
Practice Address - Street 1:34 ROUTE 30N
Practice Address - Street 2:
Practice Address - City:BOMOSEEN
Practice Address - State:VT
Practice Address - Zip Code:05732
Practice Address - Country:US
Practice Address - Phone:802-468-5777
Practice Address - Fax:802-468-5818
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0330002331183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist