Provider Demographics
NPI:1053447755
Name:MAURO, A FRANK (RPH)
Entity Type:Individual
Prefix:MR
First Name:A FRANK
Middle Name:
Last Name:MAURO
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:PO BOX 579
Mailing Address - Street 2:10504 MAIN ST
Mailing Address - City:NORTH COLLINS
Mailing Address - State:NY
Mailing Address - Zip Code:14111-0579
Mailing Address - Country:US
Mailing Address - Phone:716-337-2992
Mailing Address - Fax:716-337-3090
Practice Address - Street 1:10504 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH COLLINS
Practice Address - State:NY
Practice Address - Zip Code:14111-0579
Practice Address - Country:US
Practice Address - Phone:716-337-2992
Practice Address - Fax:716-337-3090
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027919183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00608282Medicaid
NY0719460001Medicare ID - Type Unspecified