Provider Demographics
NPI:1205368040
Name:VELLIAN, JESSY
Entity Type:Individual
Prefix:
First Name:JESSY
Middle Name:
Last Name:VELLIAN
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 1:300 PULLMAN ST BLDG G
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-9756
Mailing Address - Country:US
Mailing Address - Phone:925-960-6996
Mailing Address - Fax:
Practice Address - Street 1:300 PULLMAN ST BLDG G
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551-9756
Practice Address - Country:US
Practice Address - Phone:925-960-6996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46996183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist