Provider Demographics
NPI:1962666198
Name:BARTLEY, VINCE L (RPH)
Entity Type:Individual
Prefix:MR
First Name:VINCE
Middle Name:L
Last Name:BARTLEY
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 388
Mailing Address - Street 2:19479 HIGHWAY 167
Mailing Address - City:BENTLEY
Mailing Address - State:LA
Mailing Address - Zip Code:71407-0388
Mailing Address - Country:US
Mailing Address - Phone:318-646-6877
Mailing Address - Fax:318-646-6800
Practice Address - Street 1:19479 HWY 167
Practice Address - Street 2:
Practice Address - City:BENTLEY
Practice Address - State:LA
Practice Address - Zip Code:71407-0388
Practice Address - Country:US
Practice Address - Phone:318-646-6877
Practice Address - Fax:318-646-6800
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist