Provider Demographics
NPI:1700056603
Name:VERMILLION, DENNIS GENE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:GENE
Last Name:VERMILLION
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 W ACEQUIA AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6131
Mailing Address - Country:US
Mailing Address - Phone:559-734-5893
Mailing Address - Fax:559-734-5966
Practice Address - Street 1:535 W ACEQUIA AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6131
Practice Address - Country:US
Practice Address - Phone:559-734-5893
Practice Address - Fax:559-734-5966
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH40968183500000X, 1835G0303X, 1835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No1835P1300XPharmacy Service ProvidersPharmacistPsychiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA444920Medicaid
CAPHA444920Medicaid