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Individual

PERI STARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
62 WASHINGTON STREET EXT, FAIR HAVEN, VT 05743-4402
(802) 265-3760
Mailing address
65 HOMESTEAD RD, SARATOGA SPRINGS, NY 12866-5806

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0330078234
VT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
202-0014
IMMUNIZING PHARMACIST
Enumeration date
08/13/2011
Last updated
08/13/2011
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