Healthcare Provider Details

I. General information

NPI: 1952391757
Provider Name (Legal Business Name): STEPHEN ALAN FRY PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10703 DUTCHTOWN RD
KNOXVILLE TN
37932-3208
US

IV. Provider business mailing address

12706 HEATHLAND DR
KNOXVILLE TN
37934-4441
US

V. Phone/Fax

Practice location:
  • Phone: 865-966-7496
  • Fax: 865-675-0412
Mailing address:
  • Phone: 865-675-6668
  • Fax: 865-675-0412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7954
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: