Provider Demographics
NPI:1811328420
Name:FAUSTO, FRANK
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:FAUSTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 N PARK DR
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-2128
Mailing Address - Country:US
Mailing Address - Phone:516-965-9098
Mailing Address - Fax:
Practice Address - Street 1:999 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-6614
Practice Address - Country:US
Practice Address - Phone:516-222-8841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058550183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist