Provider Demographics
NPI:1578885455
Name:VINCENT, WILLIAM BRADLEY JR (R PH)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:BRADLEY
Last Name:VINCENT
Suffix:JR
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 1:134 RAMBLING RD
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-1316
Mailing Address - Country:US
Mailing Address - Phone:716-689-9723
Mailing Address - Fax:
Practice Address - Street 1:134 RAMBLING RD
Practice Address - Street 2:
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-1316
Practice Address - Country:US
Practice Address - Phone:716-689-9723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032898183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist