Provider Demographics
NPI:1366832164
Name:VENETOS, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:VENETOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 MONUMENT RD
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-1600
Mailing Address - Country:US
Mailing Address - Phone:267-233-5021
Mailing Address - Fax:215-220-4454
Practice Address - Street 1:4000 MONUMENT RD
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19131-1600
Practice Address - Country:US
Practice Address - Phone:267-233-5021
Practice Address - Fax:215-220-4454
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-31
Last Update Date:2015-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician