Healthcare Provider Details

I. General information

NPI: 1053447755
Provider Name (Legal Business Name): A FRANK MAURO RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10504 MAIN ST
NORTH COLLINS NY
14111-0579
US

IV. Provider business mailing address

PO BOX 579 10504 MAIN ST
NORTH COLLINS NY
14111-0579
US

V. Phone/Fax

Practice location:
  • Phone: 716-337-2992
  • Fax: 716-337-3090
Mailing address:
  • Phone: 716-337-2992
  • Fax: 716-337-3090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number027919
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: