Healthcare Provider Details

I. General information

NPI: 1205201662
Provider Name (Legal Business Name): FRYS FOOD AND DRGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2015
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 E BASELINE RD
GILBERT AZ
85233-1545
US

IV. Provider business mailing address

1845 E BASELINE RD
GILBERT AZ
85233-1545
US

V. Phone/Fax

Practice location:
  • Phone: 480-539-3733
  • Fax:
Mailing address:
  • Phone: 480-539-3733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number009999
License Number StateAZ

VIII. Authorized Official

Name: MR. TERRY DAANE
Title or Position: PHARMACY DISTRICT COORDINATOR
Credential: RPH
Phone: 602-818-5260