1407069115 NPI number — FRITZS PHARMACY INC

Table of content: (NPI 1407069115)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407069115 NPI number — FRITZS PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRITZS PHARMACY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FRITZ'S PHARMACY IV
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407069115
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1063
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISBURG
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
24901-4063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-645-1890
Provider Business Mailing Address Fax Number:
866-645-0321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 RAILROAD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALDERSON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
24910-7000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-445-2956
Provider Business Practice Location Address Fax Number:
304-445-2417
Provider Enumeration Date:
05/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GLASSER
Authorized Official First Name:
NORMAN
Authorized Official Middle Name:
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
304-645-1890

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  SP0552467 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2145521 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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