Provider Demographics
NPI:1013416189
Name:FAPORE, MICHAEL JOSEPH (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:FAPORE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 CIN D LN
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-2755
Mailing Address - Country:US
Mailing Address - Phone:814-445-8716
Mailing Address - Fax:814-445-5410
Practice Address - Street 1:131 S PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-2189
Practice Address - Country:US
Practice Address - Phone:814-443-9500
Practice Address - Fax:814-445-5410
Is Sole Proprietor?:No
Enumeration Date:2018-02-05
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP032299L183500000X, 163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018101400002Medicaid