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NPI Code Detail

MEDICARE: SOPHANAROTH PENH

MEDICARE: SOPHANAROTH PENH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist033.0135925VT
2183500000XPharmacistPH1002621MA

General Provider Information

NPI Number : 1467319202
Entity Type Code : Individual
Provider Name (Legal Business Name) : SOPHANAROTH PENH
Provider Business Mailing Address
First Line : 11 PARK ST UNIT 415
Second Line :
City : ESSEX JUNCTION
State : VT
Zip : 05452-4175
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 71 BOXWOOD ST
Second Line :
City : WILLISTON
State : VT
Zip : 05495-8211
Country : US
Telephone Number : 802-878-9056
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2026
Last Update Date : 01/05/2026

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Directions to “ SOPHANAROTH PENH ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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