Healthcare Provider Details

I. General information

NPI: 1184993347
Provider Name (Legal Business Name): WILLIAM RALPH VINCENT III PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2011
Last Update Date: 12/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 DEKALB AVE
BROOKLYN NY
11201-5425
US

IV. Provider business mailing address

121 DEKALB AVE
BROOKLYN NY
11201-5425
US

V. Phone/Fax

Practice location:
  • Phone: 718-250-8000
  • Fax: 718-250-6480
Mailing address:
  • Phone: 718-250-8000
  • Fax: 718-250-6480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number053038
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: