Provider Demographics
NPI:1689473399
Name:COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION
Entity type:Organization
Organization Name:COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTZER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:508-272-1390
Mailing Address - Street 1:420 GROVE ST STE 2
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:VT
Mailing Address - Zip Code:05733-9062
Mailing Address - Country:US
Mailing Address - Phone:802-465-0011
Mailing Address - Fax:
Practice Address - Street 1:62 WOODSTOCK AVE
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-3534
Practice Address - Country:US
Practice Address - Phone:802-775-4321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy