Provider Demographics
NPI:1588949937
Name:REBHAN, JANE (RPH)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:REBHAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:VT
Mailing Address - Zip Code:05149-1009
Mailing Address - Country:US
Mailing Address - Phone:802-228-8477
Mailing Address - Fax:802-228-2918
Practice Address - Street 1:213 MAIN ST
Practice Address - Street 2:
Practice Address - City:LUDLOW
Practice Address - State:VT
Practice Address - Zip Code:05149-1009
Practice Address - Country:US
Practice Address - Phone:802-228-8477
Practice Address - Fax:802-228-2918
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0003016183500000X
CT0006260183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist