Provider Demographics
NPI:1306177704
Name:DE VERA INC
Entity Type:Organization
Organization Name:DE VERA INC
Other - Org Name:ECOMPOUNDING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PIERRE
Authorized Official - Middle Name:PELAYO
Authorized Official - Last Name:NARVADES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:818-610-1229
Mailing Address - Street 1:21250 CALIFA ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-5001
Mailing Address - Country:US
Mailing Address - Phone:818-610-1229
Mailing Address - Fax:818-715-9710
Practice Address - Street 1:21250 CALIFA ST STE 109
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-5031
Practice Address - Country:US
Practice Address - Phone:818-610-1229
Practice Address - Fax:818-715-9710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-25
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY50194333600000X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY 50194OtherSTATE BOARD OF PHARMACY