MEDICARE: JEFFREY CRAIG FARACE RPH

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
1	183500000X	Pharmacist	09800	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	09800	OTHER	MD	STATE LICENSE

General Provider Information

NPI Number	:	1750440566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY CRAIG FARACE RPH

Provider Business Mailing Address
First Line	:	725 S SALISBURY BLVD
Second Line	:
City	:	SALISBURY
State	:	MD
Zip	:	21801-5812
Country	:	US
Telephone Number	:	410-749-1899
Fax Number	:

Provider Business Practice Location Address
First Line	:	725 S SALISBURY BLVD
Second Line	:
City	:	SALISBURY
State	:	MD
Zip	:	21801-5812
Country	:	US
Telephone Number	:	410-749-1899
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2006
Last Update Date	:	07/08/2007

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