Active NPI
Jeffrey Faneck, PHARMD
- Pharmacist
- Philadelphia, PA
National Provider Identifier
1679889570
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RP442250
- Practice address
- 3601 Midvale Ave
Philadelphia, PA 19129-1712 - Phone
- (215) 842-2950
- NPI assigned
- Aug 30, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RP442250 | PA | Primary |
| Pharmacist | 183500000X | PR5192 | ME |
Addresses
Primary practice location
3601 Midvale Ave
Philadelphia, PA 19129-1712
Mailing address
1907 Cherrie Cir
Blue Bell, PA 19422-3415
Phone (610) 308-4033
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PR5192 | ME | MD | Pharmacist |
| RP442250 | PA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1283126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1283126400000",
"number": "1679889570",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1907 CHERRIE CIR",
"city": "BLUE BELL",
"state": "PA",
"postal_code": "194223415",
"telephone_number": "610-308-4033"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3601 MIDVALE AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191291712",
"telephone_number": "215-842-2950"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FANECK",
"first_name": "JEFFREY",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-08-30",
"last_updated": "2010-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "PA",
"license": "RP442250",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ME",
"license": "PR5192",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.