Provider Demographics
NPI:1730583931
Name:BARRE PHARMACY LLC
Entity type:Organization
Organization Name:BARRE PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MAYUR
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-401-5301
Mailing Address - Street 1:20 S MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-4826
Mailing Address - Country:US
Mailing Address - Phone:802-479-3381
Mailing Address - Fax:802-479-0640
Practice Address - Street 1:20 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-4826
Practice Address - Country:US
Practice Address - Phone:802-479-3381
Practice Address - Fax:802-479-0640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-16
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VT038.00033523336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2150111OtherPK
VT1024468Medicaid
VT7296820001Medicare NSC