Provider Demographics
NPI:1447568498
Name:RENAUD, LARRY ALBERT (RPH)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:ALBERT
Last Name:RENAUD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 ROUTE 15 WEST
Mailing Address - Street 2:
Mailing Address - City:HARDWICK
Mailing Address - State:VT
Mailing Address - Zip Code:05843
Mailing Address - Country:US
Mailing Address - Phone:802-472-6961
Mailing Address - Fax:802-472-8207
Practice Address - Street 1:82 RT 15 W
Practice Address - Street 2:
Practice Address - City:HARDWICK
Practice Address - State:VT
Practice Address - Zip Code:05843
Practice Address - Country:US
Practice Address - Phone:802-472-6961
Practice Address - Fax:802-472-8207
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0003198183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist