Provider Demographics
NPI:1265612444
Name:LAFASCIANO, ANDREA N (RPH)
Entity type:Individual
Prefix:MR
First Name:ANDREA
Middle Name:N
Last Name:LAFASCIANO
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 1:1262 DIX AVE
Mailing Address - Street 2:
Mailing Address - City:HUDSON FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12839-9618
Mailing Address - Country:US
Mailing Address - Phone:518-747-0292
Mailing Address - Fax:518-747-9451
Practice Address - Street 1:1262 DIX AVE
Practice Address - Street 2:
Practice Address - City:HUDSON FALLS
Practice Address - State:NY
Practice Address - Zip Code:12839-9618
Practice Address - Country:US
Practice Address - Phone:518-747-0292
Practice Address - Fax:518-747-9451
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040250183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00361344Medicaid