Provider Demographics
NPI:1073896502
Name:DEBRAH, VERONICA B (RPH)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:B
Last Name:DEBRAH
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 1:516 NORTHSIDE DR E
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-4841
Mailing Address - Country:US
Mailing Address - Phone:912-489-3008
Mailing Address - Fax:912-489-3075
Practice Address - Street 1:516 NORTHSIDE DR E
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-4841
Practice Address - Country:US
Practice Address - Phone:912-489-3008
Practice Address - Fax:912-489-3008
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist