MEDICARE: DR. VINCENT S DETORE II PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P1200X	Pharmacotherapy Pharmacist	RP442887	PA

General Provider Information

NPI Number	:	1104144633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINCENT S DETORE II PHARMD

Provider Business Mailing Address
First Line	:	721 BEAR RUN DR
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15237-1491
Country	:	US
Telephone Number	:	724-309-2827
Fax Number	:

Provider Business Practice Location Address
First Line	:	3730 BRIGHTON RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15212-1966
Country	:	US
Telephone Number	:	412-761-3363
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2010
Last Update Date	:	05/07/2010

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