Provider Demographics
NPI:1417712829
Name:KONJE, VETALISE CHEOFOR (PHARMD)
Entity Type:Individual
Prefix:
First Name:VETALISE
Middle Name:CHEOFOR
Last Name:KONJE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:VETALISE
Other - Middle Name:KONJE
Other - Last Name:CHEOFOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6590 ROBINDALE DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-6137
Mailing Address - Country:US
Mailing Address - Phone:734-444-7862
Mailing Address - Fax:
Practice Address - Street 1:313 S ROOSEVELT DR
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:OR
Practice Address - Zip Code:97138-6743
Practice Address - Country:US
Practice Address - Phone:503-738-8422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0019932183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist