Provider Demographics
NPI:1598846198
Name:VANCUREN, PRESTON LEE (RPH)
Entity Type:Individual
Prefix:MR
First Name:PRESTON
Middle Name:LEE
Last Name:VANCUREN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 258
Mailing Address - Street 2:
Mailing Address - City:PORTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14770-0258
Mailing Address - Country:US
Mailing Address - Phone:907-486-4490
Mailing Address - Fax:
Practice Address - Street 1:21 SUNSET RIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:PORTVILLE
Practice Address - State:NY
Practice Address - Zip Code:14770-0258
Practice Address - Country:US
Practice Address - Phone:907-486-4490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1233183500000X
NY045743-1183500000X
WY2599183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist