Basic Information
| Provider Information | |||||||||
| NPI: | 1255427670 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VERMILYEA | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | GEORGE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 925 N SINAGUA HEIGHTS DR | ||||||||
| Address2: | |||||||||
| City: | FLAGSTAFF | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860047870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9282896118 | ||||||||
| FaxNumber: | 9282896293 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 INDIANA AVE | ||||||||
| Address2: | PHARMACY DEPT | ||||||||
| City: | WINSLOW | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860472169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9282896118 | ||||||||
| FaxNumber: | 9282896293 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 8348 | CT | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.