Provider Demographics
NPI:1912931585
Name:FAROLINO, DENISE ANN
Entity Type:Individual
Prefix:MISS
First Name:DENISE
Middle Name:ANN
Last Name:FAROLINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 EVANS ST
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-4105
Mailing Address - Country:US
Mailing Address - Phone:716-862-8793
Mailing Address - Fax:716-862-7812
Practice Address - Street 1:3345 BAILEY AVENUE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215
Practice Address - Country:US
Practice Address - Phone:716-862-8793
Practice Address - Fax:716-862-7812
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034073-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist