Individual
VONCENIA VANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5424 JACKSON ST, MERRILLVILLE, IN 46410-1447
(219) 884-4372
Mailing address
1225 E RIDGE RD, GRIFFITH, IN 46319-1461
(219) 838-4280
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
26020090A
IN
Other
Enumeration date
01/20/2012
Last updated
01/19/2021
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