Organization
MAXWELLS PHARMACY INC
Active
Other names
Lakeside Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE MAXWELL (PRESIDENT/TRES.)
(802) 862-1491
Entity
Organization
Contact information
Practice address
242 PEARL ST, BURLINGTON, VT 05401-8532
(802) 862-1491
Mailing address
242 PEARL ST, BURLINGTON, VT 05401-8532
(802) 862-1491
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006673
—
VT
Enumeration date
08/31/2006
Last updated
03/07/2023
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