Provider Demographics
NPI:1003411695
Name:VERES, SHAWN RAIE (BS PHARMACY)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:RAIE
Last Name:VERES
Suffix:
Gender:M
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4610 LOIS DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-5304
Mailing Address - Country:US
Mailing Address - Phone:404-991-0547
Mailing Address - Fax:
Practice Address - Street 1:100 PERIMETER CENTER PL NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30346-1204
Practice Address - Country:US
Practice Address - Phone:678-259-0889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH023548183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist