Healthcare Provider Details

I. General information

NPI: 1487639399
Provider Name (Legal Business Name): JAYSON SCOTT VERDICK PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 1ST ST SW
ROCHESTER MN
55905-0001
US

IV. Provider business mailing address

2046 SCENIC POINT DR SW
ROCHESTER MN
55902-2541
US

V. Phone/Fax

Practice location:
  • Phone: 507-284-2021
  • Fax: 507-284-5824
Mailing address:
  • Phone: 507-529-1092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number116753-1
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: