Healthcare Provider Details

I. General information

NPI: 1952581043
Provider Name (Legal Business Name): MICHAEL WARREN FANCHER R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6914 ERIE RD
DERBY NY
14047-9665
US

IV. Provider business mailing address

4708 JOHN MICHAEL WAY
HAMBURG NY
14075-1121
US

V. Phone/Fax

Practice location:
  • Phone: 716-947-4067
  • Fax: 716-947-4103
Mailing address:
  • Phone: 716-649-1169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number035378
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: