Provider Demographics
NPI:1881401065
Name:YEAGER, BLADEN SETH
Entity type:Individual
Prefix:
First Name:BLADEN
Middle Name:SETH
Last Name:YEAGER
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 1:208 VERMONT ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213-3506
Mailing Address - Country:US
Mailing Address - Phone:814-203-8016
Mailing Address - Fax:
Practice Address - Street 1:15 HONEOYE CMNS
Practice Address - Street 2:
Practice Address - City:HONEOYE
Practice Address - State:NY
Practice Address - Zip Code:14471-8809
Practice Address - Country:US
Practice Address - Phone:585-229-2285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072322183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist