Basic Information
| Provider Information | |||||||||
| NPI: | 1780776542 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FEARNO | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | PHARMACIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2064 DOUGLAS LN | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863015383 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287782216 | ||||||||
| FaxNumber: | 9287766036 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 N HWY 89 | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284454860 | ||||||||
| FaxNumber: | 9287766036 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 6138 | AZ | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.