Provider Demographics
NPI:1558733550
Name:SEVERN, VINCENT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:
Last Name:SEVERN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26251 BLUESTONE BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-2826
Mailing Address - Country:US
Mailing Address - Phone:216-242-0000
Mailing Address - Fax:877-953-2494
Practice Address - Street 1:26251 BLUESTONE BLVD STE 1
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-2826
Practice Address - Country:US
Practice Address - Phone:216-242-0000
Practice Address - Fax:877-953-2494
Is Sole Proprietor?:No
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03230225183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist