Provider Demographics
NPI:1073818670
Name:FAIRCHILD, DAVID ALLEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALLEN
Last Name:FAIRCHILD
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 1:238 LAFAYETTE STREET
Mailing Address - Street 2:K MART PHARMACY 7547
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140
Mailing Address - Country:US
Mailing Address - Phone:740-852-0878
Mailing Address - Fax:
Practice Address - Street 1:238 LAFAYETTE STREET
Practice Address - Street 2:K MART PHARMACY 7547
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140
Practice Address - Country:US
Practice Address - Phone:740-852-0878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03310473183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist