Healthcare Provider Details

I. General information

NPI: 1144821851
Provider Name (Legal Business Name): CHRISTOPHER FRALEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 WAVERLY PLZ
WAVERLY OH
45690-1222
US

IV. Provider business mailing address

220 WAVERLY PLZ
WAVERLY OH
45690-1222
US

V. Phone/Fax

Practice location:
  • Phone: 740-947-0128
  • Fax:
Mailing address:
  • Phone: 740-947-0128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03335133
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: