Provider Demographics
NPI:1861848475
Name:FACCHINI, MARK W (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:W
Last Name:FACCHINI
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 1:5044 N BARTON AVE
Mailing Address - Street 2:MAILSTOP HC81, ATTN: PHARMACY
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93740-0001
Mailing Address - Country:US
Mailing Address - Phone:559-278-6761
Mailing Address - Fax:559-278-6080
Practice Address - Street 1:5044 N BARTON AVE
Practice Address - Street 2:MAILSTOP HC81, ATTN: PHARMACY
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93740-0001
Practice Address - Country:US
Practice Address - Phone:559-278-6761
Practice Address - Fax:559-278-6080
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA402521835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist