Provider Demographics
NPI:1003411695
Name:VERES, SHAWN RAIE (BS PHARMACY)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:RAIE
Last Name:VERES
Suffix:
Gender:M
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 RIDGETOP RD
Mailing Address - Street 2:
Mailing Address - City:TRYON
Mailing Address - State:NC
Mailing Address - Zip Code:28782-7694
Mailing Address - Country:US
Mailing Address - Phone:919-671-1091
Mailing Address - Fax:
Practice Address - Street 1:177 FOREST GATE DR.
Practice Address - Street 2:
Practice Address - City:PISGAH FOREST
Practice Address - State:NC
Practice Address - Zip Code:28768-0000
Practice Address - Country:US
Practice Address - Phone:828-885-7904
Practice Address - Fax:828-885-7906
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15576183500000X
GARPH023548183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist