Provider Demographics
NPI:1659898658
Name:VESELOVA, NATALIA G (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:NATALIA
Middle Name:G
Last Name:VESELOVA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2590 LAKEVIEW DR APT 2
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-4551
Mailing Address - Country:US
Mailing Address - Phone:415-225-1297
Mailing Address - Fax:
Practice Address - Street 1:2730 GATEWAY ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-7705
Practice Address - Country:US
Practice Address - Phone:541-632-7094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORORRPH00158613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy