Provider Demographics
NPI:1376312652
Name:VINCENT, BOBBY III (MS, PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:
Last Name:VINCENT
Suffix:III
Gender:M
Credentials:MS, PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 ALBERTSTONE CIR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-2537
Mailing Address - Country:US
Mailing Address - Phone:804-218-8917
Mailing Address - Fax:
Practice Address - Street 1:8100 ALBERTSTONE CIR
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-2537
Practice Address - Country:US
Practice Address - Phone:804-218-8917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202218258183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist