Healthcare Provider Details

I. General information

NPI: 1740883677
Provider Name (Legal Business Name): EMILY FAXON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY DILELLA RPH

II. Dates (important events)

Enumeration Date: 11/21/2020
Last Update Date: 11/21/2020
Certification Date: 11/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1259 STATE ROUTE 332
FARMINGTON NY
14425-8915
US

IV. Provider business mailing address

161 WATERSONG TRL
WEBSTER NY
14580-4617
US

V. Phone/Fax

Practice location:
  • Phone: 585-742-1910
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberI063950-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: