Provider Demographics
NPI:1750870689
Name:LITTLEWOOD, MARK D (RPH)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:LITTLEWOOD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01468-1131
Mailing Address - Country:US
Mailing Address - Phone:978-939-7701
Mailing Address - Fax:
Practice Address - Street 1:499 CANAL ST
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-7112
Practice Address - Country:US
Practice Address - Phone:802-257-4204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH20336183500000X
VT033.0129468183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist