Provider Demographics
NPI:1952514580
Name:VETCENTRIC INC
Entity Type:Organization
Organization Name:VETCENTRIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACTING DIRECTOR PHARMACY
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:R
Authorized Official - Last Name:RAITT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD RPH
Authorized Official - Phone:410-266-8818
Mailing Address - Street 1:451 DEFENSE HIGHWAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401
Mailing Address - Country:US
Mailing Address - Phone:410-266-8818
Mailing Address - Fax:410-266-6483
Practice Address - Street 1:451 DEFENSE HIGHWAY
Practice Address - Street 2:SUITE C
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:410-266-8818
Practice Address - Fax:410-266-6483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPW0229333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2131857OtherNCPDP