Healthcare Provider Details

I. General information

NPI: 1700100260
Provider Name (Legal Business Name): JOHN C FAFINSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2010
Last Update Date: 10/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 S STOUGHTON RD SUITE 300
MADISON WI
53716-2257
US

IV. Provider business mailing address

1821 S STOUGHTON RD SUITE 300
MADISON WI
53716-2257
US

V. Phone/Fax

Practice location:
  • Phone: 608-260-6500
  • Fax: 608-260-6510
Mailing address:
  • Phone: 608-260-6500
  • Fax: 608-260-6510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11507-040
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: