Provider Demographics
NPI:1043081177
Name:MINA, ALENN DAVE VERZOSA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALENN DAVE
Middle Name:VERZOSA
Last Name:MINA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2895 ARBORVIEW DR APT 22
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49685-7368
Mailing Address - Country:US
Mailing Address - Phone:989-493-4611
Mailing Address - Fax:
Practice Address - Street 1:3900 N US HIGHWAY 31 S
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4447
Practice Address - Country:US
Practice Address - Phone:231-922-9277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302415705183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist