Provider Demographics
NPI:1912026329
Name:VEDDER, GEORGE W (RPH)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:W
Last Name:VEDDER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2322 200TH AVE
Mailing Address - Street 2:PO BOX 363
Mailing Address - City:MORA
Mailing Address - State:MN
Mailing Address - Zip Code:55051-0363
Mailing Address - Country:US
Mailing Address - Phone:320-679-4013
Mailing Address - Fax:
Practice Address - Street 1:2322 200TH AVE
Practice Address - Street 2:
Practice Address - City:MORA
Practice Address - State:MN
Practice Address - Zip Code:55051-0363
Practice Address - Country:US
Practice Address - Phone:320-679-4013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1109557183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist