Healthcare Provider Details

I. General information

NPI: 1588944631
Provider Name (Legal Business Name): PAUL VERMAAK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 08/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5036 FERRELL PKWY
VIRGINIA BEACH VA
23464-8867
US

IV. Provider business mailing address

4499 PADDOCK LN
VIRGINIA BEACH VA
23464-3312
US

V. Phone/Fax

Practice location:
  • Phone: 757-495-3088
  • Fax:
Mailing address:
  • Phone: 757-312-8085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202207915
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: