Provider Demographics
NPI:1174976161
Name:JOY, JOHN (PHARMACIST)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:JOY
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 VT ROUTE 14
Mailing Address - Street 2:
Mailing Address - City:NORTH MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05666-8000
Mailing Address - Country:US
Mailing Address - Phone:802-454-8643
Mailing Address - Fax:
Practice Address - Street 1:321 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404-1380
Practice Address - Country:US
Practice Address - Phone:802-655-5473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0002869183500000X
UT7699207-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist