Provider Demographics
NPI:1134441439
Name:FAZIO, ANTHONY (RPH)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
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 1:133 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-1742
Mailing Address - Country:US
Mailing Address - Phone:516-599-4646
Mailing Address - Fax:516-599-6383
Practice Address - Street 1:133 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-1742
Practice Address - Country:US
Practice Address - Phone:516-599-4646
Practice Address - Fax:516-599-6383
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-28
Last Update Date:2010-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039982183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist