Provider Demographics
NPI:1841582939
Name:FAZIO, JOHN E (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:E
Last Name:FAZIO
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 1:246 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-1646
Mailing Address - Country:US
Mailing Address - Phone:212-243-4987
Mailing Address - Fax:212-243-7110
Practice Address - Street 1:246 8TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-1646
Practice Address - Country:US
Practice Address - Phone:212-243-4987
Practice Address - Fax:212-243-7110
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-06
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0284671183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist