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General NPI Number Information
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NPI Number | 1427076470
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Entity Type | Individual
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Provider Name | LARRON STANLEY DOLENCE RPH
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Gender | Male
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 11/21/2019
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Provider Practice Location Address
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Address Line | 1090 GOAT SPRINGS ROAD
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City | TAOS
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State | NM
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Zip | 87571-1946
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Country | US
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Telephone | 575-758-6990
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Fax | 575-751-5210
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Provider Business Mailing Address
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Address Line | 101 N FORK RD
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City | LANDER
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State | WY
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Zip | 82520-9126
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Country | US
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Telephone | 307-335-4120
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 3142
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 15832
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License Number State | CO
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