Individual
TY MACWALTERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPHT
Contact information
Practice address
130 FISHER ROAD, CENTRAL VERMONT MEDICAL CENTER, BERLIN, VT 05602-0560
(802) 371-4857
(802) 371-4408
Mailing address
PO BOX 547, BARRE, VT 05641-0547
(802) 371-4169
Taxonomy
Speciality
Code
Description
License number
State
3336I0012X
Institutional Pharmacy
Primary
037.0001187
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
121.0000650
STATE LICENSE
VT
Enumeration date
07/13/2017
Last updated
03/17/2018
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