Provider Demographics
NPI:1649711250
Name:VERA, VANESSA (PHARMD)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:VERA
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 1:2530 CITRUS TOWER BLVD APT 18106
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6931
Mailing Address - Country:US
Mailing Address - Phone:954-812-5720
Mailing Address - Fax:
Practice Address - Street 1:717 N 14TH ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-4205
Practice Address - Country:US
Practice Address - Phone:352-787-0664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49396183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist