Provider Demographics
NPI:1447455779
Name:FARO, ALFIO (RPH)
Entity type:Individual
Prefix:MR
First Name:ALFIO
Middle Name:
Last Name:FARO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 DUE WEST DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-2162
Mailing Address - Country:US
Mailing Address - Phone:770-218-0101
Mailing Address - Fax:
Practice Address - Street 1:292 DUE WEST DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-2162
Practice Address - Country:US
Practice Address - Phone:770-218-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021089183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA021089OtherPHARMACY LICENSE