Provider Demographics
NPI:1952330961
Name:FARIS PHARMACY INC
Entity Type:Organization
Organization Name:FARIS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:FARIS
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:585-663-6950
Mailing Address - Street 1:2050 LATTA ROAD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14612
Mailing Address - Country:US
Mailing Address - Phone:585-663-6950
Mailing Address - Fax:585-663-5248
Practice Address - Street 1:2050 LATTA ROAD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612
Practice Address - Country:US
Practice Address - Phone:585-663-6950
Practice Address - Fax:585-663-5248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0162863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0172010001Medicare NSC