Provider Demographics
NPI:1417282526
Name:FATA, FRANCIS L (RPH)
Entity Type:Individual
Prefix:
First Name:FRANCIS
Middle Name:L
Last Name:FATA
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 1:11215 72ND ROAD
Mailing Address - Street 2:UNIT LL5
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6647
Mailing Address - Country:US
Mailing Address - Phone:718-793-6747
Mailing Address - Fax:718-228-7166
Practice Address - Street 1:11215 72ND ROAD
Practice Address - Street 2:UNIT LL5
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-793-6747
Practice Address - Fax:718-228-7166
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY39544183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist