Healthcare Provider Details

I. General information

NPI: 1477885093
Provider Name (Legal Business Name): BRAD VACCHETTO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2010
Last Update Date: 02/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 E RIDGE RD
ROCHESTER NY
14621-2006
US

IV. Provider business mailing address

300 NORTH AVE
ROCHESTER NY
14626-1068
US

V. Phone/Fax

Practice location:
  • Phone: 585-467-1040
  • Fax:
Mailing address:
  • Phone: 585-225-2369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number047814
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: