Provider Demographics
NPI:1225634819
Name:VERKUILEN, DALE (BS PHARMACY)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:
Last Name:VERKUILEN
Suffix:
Gender:M
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFITH
Mailing Address - State:IN
Mailing Address - Zip Code:46319-1532
Mailing Address - Country:US
Mailing Address - Phone:219-484-9150
Mailing Address - Fax:
Practice Address - Street 1:1195 E RIDGE RD
Practice Address - Street 2:
Practice Address - City:GRIFFITH
Practice Address - State:IN
Practice Address - Zip Code:46319-1367
Practice Address - Country:US
Practice Address - Phone:219-923-7907
Practice Address - Fax:219-923-3039
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018692A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist