Provider Demographics
NPI:1457058653
Name:PROVERI VENTURES LLC
Entity type:Organization
Organization Name:PROVERI VENTURES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:USOF
Authorized Official - Middle Name:
Authorized Official - Last Name:HASHIM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:240-481-3128
Mailing Address - Street 1:1524 MCHENRY AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4575
Mailing Address - Country:US
Mailing Address - Phone:209-662-7272
Mailing Address - Fax:209-795-4316
Practice Address - Street 1:1524 MCHENRY AVE STE 160
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4575
Practice Address - Country:US
Practice Address - Phone:209-662-7272
Practice Address - Fax:209-795-4316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy