Provider Demographics
NPI:1487961629
Name:EISENBIEGLER, CARL PETER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:PETER
Last Name:EISENBIEGLER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 PAUS LN
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:VT
Mailing Address - Zip Code:05655-4428
Mailing Address - Country:US
Mailing Address - Phone:978-590-1923
Mailing Address - Fax:
Practice Address - Street 1:407 BROAD ST
Practice Address - Street 2:KINNEY DRUGS #94
Practice Address - City:LYNDONVILLE
Practice Address - State:VT
Practice Address - Zip Code:05851-5600
Practice Address - Country:US
Practice Address - Phone:802-626-3779
Practice Address - Fax:802-626-1089
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0003794183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist