Healthcare Provider Details

I. General information

NPI: 1881401065
Provider Name (Legal Business Name): BLADEN SETH YEAGER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 HONEOYE CMNS
HONEOYE NY
14471-8809
US

IV. Provider business mailing address

208 VERMONT ST APT 1
BUFFALO NY
14213-3506
US

V. Phone/Fax

Practice location:
  • Phone: 585-229-2285
  • Fax:
Mailing address:
  • Phone: 814-203-8016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number072322
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: