Provider Demographics
NPI:1801239272
Name:VERO PHARMACY INC
Entity type:Organization
Organization Name:VERO PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAZI
Authorized Official - Middle Name:
Authorized Official - Last Name:IMAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-562-3660
Mailing Address - Street 1:1635 14TH AV
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960
Mailing Address - Country:US
Mailing Address - Phone:772-562-3660
Mailing Address - Fax:772-770-4118
Practice Address - Street 1:1635 14TH AV
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960
Practice Address - Country:US
Practice Address - Phone:772-562-3660
Practice Address - Fax:772-770-4118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-16
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH267843336C0003X
3336L0003X
FLPH309533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2140485OtherPK