Provider Demographics
NPI:1003049644
Name:FANTON, DOLORES PFRENGLE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DOLORES
Middle Name:PFRENGLE
Last Name:FANTON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8082 TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-9126
Mailing Address - Country:US
Mailing Address - Phone:585-624-3751
Mailing Address - Fax:
Practice Address - Street 1:8082 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-9126
Practice Address - Country:US
Practice Address - Phone:585-624-3751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0299604183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist