Provider Demographics
NPI:1205214905
Name:DENOFER, JON
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:DENOFER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 RUTLAND SHOPPING PLZ
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-5201
Mailing Address - Country:US
Mailing Address - Phone:802-747-7887
Mailing Address - Fax:802-786-0926
Practice Address - Street 1:38 RUTLAND SHOPPING PLZ
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-5201
Practice Address - Country:US
Practice Address - Phone:802-747-7887
Practice Address - Fax:802-786-0926
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0002840183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist