Provider Demographics
NPI:1841667128
Name:FACCONE, JOHN JOSEPH (RPH)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JOSEPH
Last Name:FACCONE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1215 TROY SCHENECTADY RD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-1011
Mailing Address - Country:US
Mailing Address - Phone:518-782-1890
Mailing Address - Fax:518-782-1495
Practice Address - Street 1:1215 TROY SCHENECTADY RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1011
Practice Address - Country:US
Practice Address - Phone:518-782-1890
Practice Address - Fax:518-782-1495
Is Sole Proprietor?:No
Enumeration Date:2015-08-21
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI060860183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist