Idona Jean Jelen Eberhardt, RPH
Individual provider Active NPI Pharmacist · Glover, VT
NPI 1013205335 · NPPES record last updated Jul 20, 2011
Key facts
- NPI
- 1013205335
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- VT3619 (VT)
- Practice address
- 1043 Dexter Mountain Rd
Glover, VT 05839-9665 - Phone
- (802) 525-3152
- NPI assigned
- Jul 20, 2011
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS26840 | FL | MD | Pharmacist |
| VT3619 | VT | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | VT3619 | VT | Yes |
| Pharmacist | 183500000X | PS26840 | FL |
Addresses
Primary practice location
1043 Dexter Mountain Rd
Glover, VT 05839-9665
Mailing address
1043 Dexter Mountain Rd
Glover, VT 05839-9665
Phone (802) 525-3152
Other providers in Glover, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 20, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.