Provider Demographics
NPI:1811510233
Name:VERHEEM, EMMARANCE
Entity type:Individual
Prefix:MRS
First Name:EMMARANCE
Middle Name:
Last Name:VERHEEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 RUBINO CT
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-0778
Mailing Address - Country:US
Mailing Address - Phone:760-419-2821
Mailing Address - Fax:
Practice Address - Street 1:51101 CESAR CHAVEZ ST
Practice Address - Street 2:
Practice Address - City:COACHELLA
Practice Address - State:CA
Practice Address - Zip Code:92236-1560
Practice Address - Country:US
Practice Address - Phone:760-398-0833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45965183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist