Provider Demographics
NPI:1861674293
Name:FATUROS, ARTHUR E (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:E
Last Name:FATUROS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 WHITEHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-1935
Mailing Address - Country:US
Mailing Address - Phone:716-773-3672
Mailing Address - Fax:
Practice Address - Street 1:1381 NASH RD
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-2338
Practice Address - Country:US
Practice Address - Phone:716-694-0022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23884183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01818735Medicaid