Individual
JASON TO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
49 WRIGHT AVE, WILLISTON, VT 05495-4419
(802) 872-8840
Mailing address
49 WRIGHT AVE, WILLISTON, VT 05495-4419
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
033.0103766
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
033.0103766
STATE LICENSE
VT
Enumeration date
05/09/2020
Last updated
05/09/2020
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