Provider Demographics
NPI:1952581043
Name:FANCHER, MICHAEL WARREN (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:WARREN
Last Name:FANCHER
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 1:4708 JOHN MICHAEL WAY
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-1121
Mailing Address - Country:US
Mailing Address - Phone:716-649-1169
Mailing Address - Fax:
Practice Address - Street 1:6914 ERIE RD
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:NY
Practice Address - Zip Code:14047-9665
Practice Address - Country:US
Practice Address - Phone:716-947-4067
Practice Address - Fax:716-947-4103
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035378183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist