Provider Demographics
NPI:1952601429
Name:FANNING, JOSEPH EWARD (RPH)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:EWARD
Last Name:FANNING
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 1:1944 WHITE OAK WAY
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070
Mailing Address - Country:US
Mailing Address - Phone:650-593-6840
Mailing Address - Fax:
Practice Address - Street 1:2100 RALSTON AVE
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002
Practice Address - Country:US
Practice Address - Phone:650-591-6918
Practice Address - Fax:650-591-8043
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 30384183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist