Provider Demographics
NPI:1720125826
Name:VEACH, STEVIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:STEVIE
Middle Name:
Last Name:VEACH
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 1:555 W CHERRY ST
Mailing Address - Street 2:P.O. BOX 287
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-9797
Mailing Address - Country:US
Mailing Address - Phone:319-626-6188
Mailing Address - Fax:319-626-6195
Practice Address - Street 1:555 W CHERRY ST
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-9797
Practice Address - Country:US
Practice Address - Phone:319-626-6188
Practice Address - Fax:319-626-6195
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA20379183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0015024Medicaid