Healthcare Provider Details

I. General information

NPI: 1104144633
Provider Name (Legal Business Name): VINCENT S DETORE II PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2010
Last Update Date: 05/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3730 BRIGHTON RD
PITTSBURGH PA
15212-1966
US

IV. Provider business mailing address

721 BEAR RUN DR
PITTSBURGH PA
15237-1491
US

V. Phone/Fax

Practice location:
  • Phone: 412-761-3363
  • Fax:
Mailing address:
  • Phone: 724-309-2827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRP442887
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: