Provider Demographics
NPI:1568898310
Name:VERZINO, ROBERT LEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEE
Last Name:VERZINO
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 1:33055 MINDY WAY
Mailing Address - Street 2:
Mailing Address - City:SCAPPOOSE
Mailing Address - State:OR
Mailing Address - Zip Code:97056-3128
Mailing Address - Country:US
Mailing Address - Phone:602-653-0342
Mailing Address - Fax:
Practice Address - Street 1:33055 MINDY WAY
Practice Address - Street 2:
Practice Address - City:SCAPPOOSE
Practice Address - State:OR
Practice Address - Zip Code:97056-3128
Practice Address - Country:US
Practice Address - Phone:602-653-0342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH 10899183500000X
NMRP00005716183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist