Provider Demographics
NPI:1669771929
Name:VIERRA, VERNON FRANK (BS IN PHARMACY)
Entity type:Individual
Prefix:MR
First Name:VERNON
Middle Name:FRANK
Last Name:VIERRA
Suffix:
Gender:M
Credentials:BS IN PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 PELANDALE AVE STE 500A
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-9104
Mailing Address - Country:US
Mailing Address - Phone:209-545-0766
Mailing Address - Fax:209-545-0611
Practice Address - Street 1:3900 PELANDALE AVE STE 500A
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-9104
Practice Address - Country:US
Practice Address - Phone:209-545-0766
Practice Address - Fax:209-545-0611
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22774183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist