Provider Demographics
NPI:1174846976
Name:VINTI, JOHN (R,PH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:VINTI
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 1:173 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14204-1152
Mailing Address - Country:US
Mailing Address - Phone:716-882-0196
Mailing Address - Fax:716-882-0214
Practice Address - Street 1:173 HIGH ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14204-1152
Practice Address - Country:US
Practice Address - Phone:716-882-0196
Practice Address - Fax:716-882-0214
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030352183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00657974Medicaid
NY00657974Medicaid
NY5124270001Medicare NSC