Provider Demographics
NPI:1295178747
Name:DEFRATUS, JANET CAROL (RPH)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:CAROL
Last Name:DEFRATUS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4247
Mailing Address - Country:US
Mailing Address - Phone:970-247-9435
Mailing Address - Fax:970-385-5251
Practice Address - Street 1:3130 MAIN AVE
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4247
Practice Address - Country:US
Practice Address - Phone:970-247-9435
Practice Address - Fax:970-385-5251
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11615183500000X
NM3616183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist