Provider Demographics
NPI:1396498267
Name:BELL, WARREN BRUCE
Entity type:Individual
Prefix:
First Name:WARREN
Middle Name:BRUCE
Last Name:BELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1161 NYS ROUTE 9N
Mailing Address - Street 2:
Mailing Address - City:TICONDEROGA
Mailing Address - State:NY
Mailing Address - Zip Code:12883-3105
Mailing Address - Country:US
Mailing Address - Phone:518-585-6787
Mailing Address - Fax:
Practice Address - Street 1:1161 NYS ROUTE 9N
Practice Address - Street 2:
Practice Address - City:TICONDEROGA
Practice Address - State:NY
Practice Address - Zip Code:12883-3105
Practice Address - Country:US
Practice Address - Phone:518-585-6787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043659183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist