Individual
MR. ANTHONY JOHN FAZIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
4747-10 NESCONSET HWY, PORT JEFFERSON STATION, NY 11776-2880
(631) 474-7828
Mailing address
11 MARLA DR, CORAM, NY 11727-2723
(631) 696-1987
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
047260
NY
Other
Enumeration date
11/15/2010
Last updated
11/15/2010
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