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NPI Code Detail

MEDICARE: VERICOR ENTERPRISES INC.

MEDICARE: VERICOR ENTERPRISES INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0004XCompounding PharmacyPHY48888CA

General Provider Information

NPI Number : 1649521816
Entity Type Code : Organization
Provider Name (Legal Business Name) : VERICOR ENTERPRISES INC.
Provider Business Mailing Address
First Line : 2860 ARTESIA BLVD
Second Line :
City : REDONDO BEACH
State : CA
Zip : 90278-3421
Country : US
Telephone Number : 310-371-7541
Fax Number :
Provider Business Practice Location Address
First Line : 2860 ARTESIA BLVD
Second Line :
City : REDONDO BEACH
State : CA
Zip : 90278-3421
Country : US
Telephone Number : 310-371-7541
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. ODETTE LEONELLI
Credential : PHARMACIST
Telephone Number : 310-371-7541
Provider Enumeration Date : 09/27/2012
Last Update Date : 09/27/2012

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Directions to “VERICOR ENTERPRISES INC. ” Practice Location

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