Active NPI
Phillip Kim Favreau Jr., RPH
- Pharmacist
- Syracuse, NY
National Provider Identifier
1932537412
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 037956
- Practice address
- 736 Irving Ave
Syracuse, NY 13210 - Phone
- (315) 470-7520
- Fax
- (315) 470-7976
- NPI assigned
- Oct 22, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 037956 | NY | Primary |
Addresses
Primary practice location
736 Irving Ave
Syracuse, NY 13210
Mailing address
736 Irving Ave
Syracuse, NY 13210
Phone (315) 470-7520
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 037956 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1382400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1382400000000",
"number": "1932537412",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "736 IRVING AVE",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "13210",
"telephone_number": "315-470-7520",
"fax_number": "315-470-7976"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "736 IRVING AVE",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "13210",
"telephone_number": "315-470-7520",
"fax_number": "315-470-7976"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAVREAU",
"first_name": "PHILLIP",
"middle_name": "KIM",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-10-22",
"last_updated": "2013-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "037956",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Syracuse, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.