Provider Demographics
NPI:1306166210
Name:CREVECOEUR, VERONICA ELIZABETH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:ELIZABETH
Last Name:CREVECOEUR
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2703 PARK ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-7607
Mailing Address - Country:US
Mailing Address - Phone:904-384-8929
Mailing Address - Fax:904-384-3529
Practice Address - Street 1:2703 PARK ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-7607
Practice Address - Country:US
Practice Address - Phone:904-384-8929
Practice Address - Fax:904-384-3529
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS45566183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist