Provider Demographics
NPI:1043364516
Name:REDA, VINCENT LOUIS (BS)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:LOUIS
Last Name:REDA
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 MISTY PINE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-2630
Mailing Address - Country:US
Mailing Address - Phone:585-389-6025
Mailing Address - Fax:
Practice Address - Street 1:77 SULLYS TRL
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-3754
Practice Address - Country:US
Practice Address - Phone:585-389-6025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020-038878183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist