Provider Demographics
NPI:1073852927
Name:VEROSE, SUCHARITHA
Entity Type:Individual
Prefix:
First Name:SUCHARITHA
Middle Name:
Last Name:VEROSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6739 ABERDALE CIR
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5694
Mailing Address - Country:US
Mailing Address - Phone:925-577-7745
Mailing Address - Fax:
Practice Address - Street 1:6739 ABERDALE CIR
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582-5694
Practice Address - Country:US
Practice Address - Phone:925-577-7745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66490183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist