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General NPI Number Information
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NPI Number | 1942480520
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Entity Type | Individual
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Provider Name | MARK WILLIAM FAGNAN RPH
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Gender | Male
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Dates
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Enumeration Date | 11/12/2007
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Last Update Date | 11/17/2007
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Provider Practice Location Address
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Address Line | 507 CHEMUNG ST
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City | HORSEHEADS
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State | NY
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Zip | 14845-2711
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Country | US
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Telephone | 607-739-0301
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 696
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City | MONTOUR FALLS
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State | NY
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Zip | 14865-0696
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Country | US
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Telephone | 607-426-9754
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 045321
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License Number State | NY
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