Provider Demographics
NPI:1356659833
Name:FAVRE, DONALD MONTI (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:MONTI
Last Name:FAVRE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S 99TH AVE
Mailing Address - Street 2:BUILDING C
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-9700
Mailing Address - Country:US
Mailing Address - Phone:623-907-4932
Mailing Address - Fax:623-907-4990
Practice Address - Street 1:500 S 99TH AVE
Practice Address - Street 2:BUILDING C
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-9700
Practice Address - Country:US
Practice Address - Phone:623-907-4932
Practice Address - Fax:623-907-4990
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-19
Last Update Date:2010-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS007728183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist