Provider Demographics
NPI:1922280023
Name:VASSEL, BILLY T (RPH)
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:T
Last Name:VASSEL
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 1:90 TWIN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-1232
Mailing Address - Country:US
Mailing Address - Phone:631-663-3309
Mailing Address - Fax:
Practice Address - Street 1:161 MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON BEACH
Practice Address - State:NY
Practice Address - Zip Code:11978-2701
Practice Address - Country:US
Practice Address - Phone:631-288-5845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025677183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01564667Medicaid