Healthcare Provider Details

I. General information

NPI: 1518465459
Provider Name (Legal Business Name): VERDANT ANALYTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5991 A1A S
ST AUGUSTINE FL
32080-7017
US

IV. Provider business mailing address

5991 A1A S
ST AUGUSTINE FL
32080-7017
US

V. Phone/Fax

Practice location:
  • Phone: 904-679-5931
  • Fax: 844-272-1465
Mailing address:
  • Phone: 904-679-5931
  • Fax: 844-272-1465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPH29473
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH29473
License Number StateFL

VIII. Authorized Official

Name: DR. NAOMI BETH CONANT
Title or Position: OWNER
Credential: PHARM.D.
Phone: 904-679-5931