MEDICARE: MRS. JEAN FRIES RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP035461L	PA

General Provider Information

NPI Number	:	1861420119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JEAN FRIES RPH

Provider Business Mailing Address
First Line	:	7 SCHOOLHOUSE LN
Second Line	:
City	:	FLEETWOOD
State	:	PA
Zip	:	19522-9767
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4727 PENN AVE
Second Line	:
City	:	SINKING SPRING
State	:	PA
Zip	:	19608-9708
Country	:	US
Telephone Number	:	610-678-6610
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	07/08/2007

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