Provider Demographics
NPI:1467117960
Name:FABRY, JUSTIN (PHARM D)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:FABRY
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:MONONGAHELA
Mailing Address - State:PA
Mailing Address - Zip Code:15063-1098
Mailing Address - Country:US
Mailing Address - Phone:724-258-6101
Mailing Address - Fax:724-258-6640
Practice Address - Street 1:1300 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:MONONGAHELA
Practice Address - State:PA
Practice Address - Zip Code:15063-1098
Practice Address - Country:US
Practice Address - Phone:724-258-6101
Practice Address - Fax:724-258-6640
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP442053183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist