Basic Information
| Provider Information | |||||||||
| NPI: | 1356659833 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FAVRE | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | MONTI | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMACIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 S 99TH AVE | ||||||||
| Address2: | BUILDING C | ||||||||
| City: | TOLLESON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853539700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239074932 | ||||||||
| FaxNumber: | 6239074990 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 S 99TH AVE | ||||||||
| Address2: | BUILDING C | ||||||||
| City: | TOLLESON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853539700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239074932 | ||||||||
| FaxNumber: | 6239074990 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2010 | ||||||||
| LastUpdateDate: | 09/19/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | S007728 | AZ | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.