Provider Demographics
NPI:1194496141
Name:ZAVADA, TOMAS (RPH)
Entity type:Individual
Prefix:MR
First Name:TOMAS
Middle Name:
Last Name:ZAVADA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 ATKINSON ST
Mailing Address - Street 2:
Mailing Address - City:BELLOWS FALLS
Mailing Address - State:VT
Mailing Address - Zip Code:05101-1321
Mailing Address - Country:US
Mailing Address - Phone:802-460-2634
Mailing Address - Fax:802-460-2296
Practice Address - Street 1:78 ATKINSON ST
Practice Address - Street 2:
Practice Address - City:BELLOWS FALLS
Practice Address - State:VT
Practice Address - Zip Code:05101-1321
Practice Address - Country:US
Practice Address - Phone:802-460-2634
Practice Address - Fax:802-460-2296
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0117586183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty