Provider Demographics
NPI:1366736944
Name:DESAUTELS, DEBORAH J (PHARMD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:J
Last Name:DESAUTELS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 MEMPHREMAGOG VW # B3
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-4937
Mailing Address - Country:US
Mailing Address - Phone:802-309-3621
Mailing Address - Fax:
Practice Address - Street 1:115 SEYMOUR DRIVE
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:VT
Practice Address - Zip Code:05829
Practice Address - Country:US
Practice Address - Phone:802-309-3621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0003820183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist