Provider Demographics
NPI:1831499128
Name:JORGENSEN, MARCIE BETH (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:MARCIE
Middle Name:BETH
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 LOWER MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-5830
Mailing Address - Country:US
Mailing Address - Phone:802-655-3156
Mailing Address - Fax:802-654-7461
Practice Address - Street 1:218 LOWER MOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-5830
Practice Address - Country:US
Practice Address - Phone:802-655-3156
Practice Address - Fax:802-654-7461
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT003.0003856183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist