Healthcare Provider Details

I. General information

NPI: 1912931585
Provider Name (Legal Business Name): MISS DENISE ANN FAROLINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3345 BAILEY AVENUE
BUFFALO NY
14215
US

IV. Provider business mailing address

335 EVANS ST
NORTH TONAWANDA NY
14120-4105
US

V. Phone/Fax

Practice location:
  • Phone: 716-862-8793
  • Fax: 716-862-7812
Mailing address:
  • Phone: 716-862-8793
  • Fax: 716-862-7812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number034073-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: