Provider Demographics
NPI:1760589451
Name:FAENZA, BRIAN KEVIN (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:KEVIN
Last Name:FAENZA
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 1:2828 ALLISON LN
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-9616
Mailing Address - Country:US
Mailing Address - Phone:610-395-6886
Mailing Address - Fax:
Practice Address - Street 1:3926 NAZARETH PIKE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-1116
Practice Address - Country:US
Practice Address - Phone:610-882-1593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040604L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist