Provider Demographics
NPI:1962592279
Name:PIERCE, VERLON LANE (R PH)
Entity type:Individual
Prefix:
First Name:VERLON
Middle Name:LANE
Last Name:PIERCE
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 MOUNT AYR CIR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-4709
Mailing Address - Country:US
Mailing Address - Phone:270-782-0208
Mailing Address - Fax:270-782-8181
Practice Address - Street 1:1414 MOUNT AYR CIR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-4709
Practice Address - Country:US
Practice Address - Phone:270-782-0208
Practice Address - Fax:270-782-8181
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007389183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY007389OtherPHARMACIST