Provider Demographics
NPI:1124494422
Name:VERVERELLI, EVAGGELIA
Entity type:Individual
Prefix:
First Name:EVAGGELIA
Middle Name:
Last Name:VERVERELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S 18TH ST UNIT 405
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-4924
Mailing Address - Country:US
Mailing Address - Phone:215-713-6173
Mailing Address - Fax:
Practice Address - Street 1:13 N BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-1402
Practice Address - Country:US
Practice Address - Phone:856-740-2509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI0189930183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist