Provider Demographics
NPI:1619158706
Name:VETTER, MARC DAVID (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:DAVID
Last Name:VETTER
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 1:121 HERKIMER RD
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-2311
Mailing Address - Country:US
Mailing Address - Phone:315-733-2371
Mailing Address - Fax:315-735-6687
Practice Address - Street 1:121 HERKIMER RD
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-2311
Practice Address - Country:US
Practice Address - Phone:315-733-2371
Practice Address - Fax:315-735-6687
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-17
Last Update Date:2007-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048242183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist