Provider Demographics
NPI:1235781592
Name:CHILAKOS, JENNY A
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:A
Last Name:CHILAKOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 N MAIN ST STE 23
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-1735
Mailing Address - Country:US
Mailing Address - Phone:802-524-2141
Mailing Address - Fax:
Practice Address - Street 1:83 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5240
Practice Address - Country:US
Practice Address - Phone:514-594-7173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT134274183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist