Provider Demographics
NPI:1063292902
Name:VERELST, RYKER JUSTIN
Entity type:Individual
Prefix:DR
First Name:RYKER
Middle Name:JUSTIN
Last Name:VERELST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 FRONT ST UNIT 1142
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1447
Mailing Address - Country:US
Mailing Address - Phone:413-523-6582
Mailing Address - Fax:
Practice Address - Street 1:624 WAVERLEY ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6981
Practice Address - Country:US
Practice Address - Phone:508-935-2201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH9969923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy