Healthcare Provider Details

I. General information

NPI: 1154755155
Provider Name (Legal Business Name): VERIMED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10345 NATIONS FORD RD SUITE E
CHARLOTTE NC
28273-5822
US

IV. Provider business mailing address

10345 NATIONS FORD RD SUITE E
CHARLOTTE NC
28273-5822
US

V. Phone/Fax

Practice location:
  • Phone: 704-412-2732
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number12031
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number12031
License Number StateNC

VIII. Authorized Official

Name: PHILIP GAUCHER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 704-469-4577