Provider Demographics
NPI:1427076470
Name:DOLENCE, LARRON STANLEY (RPH)
Entity type:Individual
Prefix:
First Name:LARRON
Middle Name:STANLEY
Last Name:DOLENCE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N FORK RD
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-9126
Mailing Address - Country:US
Mailing Address - Phone:307-335-4120
Mailing Address - Fax:
Practice Address - Street 1:1090 GOAT SPRINGS ROAD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-1946
Practice Address - Country:US
Practice Address - Phone:575-758-6990
Practice Address - Fax:575-751-5210
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3142183500000X
CO15832183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist