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General NPI Number Information
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NPI Number | 1003411695
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Entity Type | Individual
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Provider Name | SHAWN RAIE VERES BS PHARMACY
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Gender | Male
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Dates
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Enumeration Date | 12/01/2020
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 177 FOREST GATE DR.
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City | PISGAH FOREST
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State | NC
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Zip | 28768-0000
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Country | US
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Telephone | 828-885-7904
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Fax | 828-885-7906
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Provider Business Mailing Address
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Address Line | 400 RIDGETOP RD
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City | TRYON
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State | NC
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Zip | 28782-7694
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Country | US
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Telephone | 919-671-1091
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 15576
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH023548
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License Number State | GA
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