Provider Demographics
NPI:1558053850
Name:LAINFIESTA, MICHAEL JAVIER (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAVIER
Last Name:LAINFIESTA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W FARMS SQUARE PLZ APT 6C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-2979
Mailing Address - Country:US
Mailing Address - Phone:718-496-0035
Mailing Address - Fax:
Practice Address - Street 1:7512 BROADWAY
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5611
Practice Address - Country:US
Practice Address - Phone:718-489-1114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070324183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist