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General NPI Number Information
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NPI Number | 1881401065
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Entity Type | Individual
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Provider Name | BLADEN SETH YEAGER
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Gender | Male
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Dates
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Enumeration Date | 12/12/2024
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 15 HONEOYE CMNS
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City | HONEOYE
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State | NY
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Zip | 14471-8809
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Country | US
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Telephone | 585-229-2285
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Fax |
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Provider Business Mailing Address
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Address Line | 208 VERMONT ST APT 1
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City | BUFFALO
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State | NY
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Zip | 14213-3506
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Country | US
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Telephone | 814-203-8016
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 072322
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License Number State | NY
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