Provider Demographics
NPI:1992942379
Name:FABIANICH, STANISLAV (RPH PHARMD)
Entity type:Individual
Prefix:
First Name:STANISLAV
Middle Name:
Last Name:FABIANICH
Suffix:
Gender:M
Credentials:RPH PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11790 STORMES DR
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44130-7735
Mailing Address - Country:US
Mailing Address - Phone:440-884-3053
Mailing Address - Fax:
Practice Address - Street 1:11790 STORMES DR
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44130-7735
Practice Address - Country:US
Practice Address - Phone:440-884-3053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03314199183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist