1972648129 NPI number — THE DRUG STORE INC

Table of content: (NPI 1972648129)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972648129 NPI number — THE DRUG STORE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE DRUG STORE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972648129
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 391
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAITSFIELD
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05673-0391
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
VILLAGE SQUARE
Provider Second Line Business Practice Location Address:
SUITE 7
Provider Business Practice Location Address City Name:
WAITSFIELD
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05673-0391
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-496-2345
Provider Business Practice Location Address Fax Number:
802-496-4337
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ODDELL
Authorized Official First Name:
AL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRES
Authorized Official Telephone Number:
802-496-2345

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 0380001074 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0007154 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4701074 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4701074 . This is a "OTHER ID NUMBER" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com