Provider Demographics
NPI:1164012233
Name:VEREEN, ALYSA MICHELLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALYSA
Middle Name:MICHELLE
Last Name:VEREEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 SEXTON AVE
Mailing Address - Street 2:
Mailing Address - City:ZEBULON
Mailing Address - State:NC
Mailing Address - Zip Code:27597-2117
Mailing Address - Country:US
Mailing Address - Phone:919-660-3788
Mailing Address - Fax:
Practice Address - Street 1:101 W GANNON AVE
Practice Address - Street 2:
Practice Address - City:ZEBULON
Practice Address - State:NC
Practice Address - Zip Code:27597-2623
Practice Address - Country:US
Practice Address - Phone:919-269-3323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30174183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist