Individual
SOPHANAROTH PENH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
71 BOXWOOD ST, WILLISTON, VT 05495-8211
(802) 878-9056
Mailing address
11 PARK ST UNIT 415, ESSEX JUNCTION, VT 05452-4175
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
033.0135925
VT
183500000X
Pharmacist
Primary
PH1002621
MA
Other
Enumeration date
01/05/2026
Last updated
01/05/2026
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