Healthcare Provider Details

I. General information

NPI: 1417990623
Provider Name (Legal Business Name): MR. DAVID WAYNE FRYE
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 LEE STREET
ROGERSVILLE AL
35652
US

IV. Provider business mailing address

5841 HIGHWAY 72 PO BOX 564
KILLEN AL
35645-8245
US

V. Phone/Fax

Practice location:
  • Phone: 256-247-5451
  • Fax:
Mailing address:
  • Phone: 256-757-2036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7278
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13953
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: