Healthcare Provider Details

I. General information

NPI: 1326656430
Provider Name (Legal Business Name): JENEL CLEMENT PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 LAKESIDE AVE STE 260
BURLINGTON VT
05401-5911
US

IV. Provider business mailing address

163 VETERANS DRIVE
WHITE RIVER JUNCTION VT
05009-0001
US

V. Phone/Fax

Practice location:
  • Phone: 802-657-7000
  • Fax: 802-296-5109
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH238846
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: