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NPI Code Detail

MEDICARE: JEFFREY FANECK PHARMD

MEDICARE: JEFFREY FANECK PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistRP442250PA
2183500000XPharmacistPR5192ME

General Provider Information

NPI Number : 1679889570
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY FANECK PHARMD
Provider Business Mailing Address
First Line : 1907 CHERRIE CIR
Second Line :
City : BLUE BELL
State : PA
Zip : 19422-3415
Country : US
Telephone Number : 610-308-4033
Fax Number :
Provider Business Practice Location Address
First Line : 3601 MIDVALE AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19129-1712
Country : US
Telephone Number : 215-842-2950
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2010
Last Update Date : 08/30/2010

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Directions to “ JEFFREY FANECK PHARMD” Practice Location

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