Provider Demographics
NPI:1962664318
Name:OLIVA, VINCENT WILLIAM (RPH)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:WILLIAM
Last Name:OLIVA
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 1:7 CANYON TRL
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-1839
Mailing Address - Country:US
Mailing Address - Phone:585-264-9708
Mailing Address - Fax:585-419-0552
Practice Address - Street 1:1659 PENFIELD RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2549
Practice Address - Country:US
Practice Address - Phone:585-419-0560
Practice Address - Fax:585-419-0552
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038464183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist