Provider Demographics
NPI:1588029854
Name:FARSETTA, MICHAEL (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:FARSETTA
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 1:2 COURTNEY DR
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-6112
Mailing Address - Country:US
Mailing Address - Phone:845-642-6097
Mailing Address - Fax:
Practice Address - Street 1:2 COURTNEY DRIVE
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956
Practice Address - Country:US
Practice Address - Phone:845-642-6097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03695500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist