Organization
MARTINS FOODS OF SOUTH BURLINGTON LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL VAIL (PRESIDENT AND MANAGER)
(207) 885-7454
Entity
Organization
Contact information
Practice address
27 41 GANESVOORT RD, S GLENS FALLS, NY 12803
(518) 798-2847
(518) 798-2913
Mailing address
PO BOX 1000, MS 3000, PORTLAND, ME 04104-5005
(207) 885-7454
(704) 645-6531
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
027784
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02753900
—
NY
01
—
2067662
PK
—
Enumeration date
10/20/2006
Last updated
04/20/2018
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