Provider Demographics
NPI:1710431259
Name:BROCK, VERNA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:VERNA
Middle Name:
Last Name:BROCK
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 1:6324 PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-2539
Mailing Address - Country:US
Mailing Address - Phone:301-938-3447
Mailing Address - Fax:
Practice Address - Street 1:6324 PATTERSON ST
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-2539
Practice Address - Country:US
Practice Address - Phone:301-938-3447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-13
Last Update Date:2016-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16903183500000X
DC100000198183500000X
FL43517183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist