Healthcare Provider Details

I. General information

NPI: 1639474562
Provider Name (Legal Business Name): FRITZ'S PHARMACY II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2011
Last Update Date: 01/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1318 JEFFERSON STREET NORTH SUITE #2
LEWISBURG WV
24901-1063
US

IV. Provider business mailing address

1318 JEFFERSON STREET NORTH SUITE #2
LEWISBURG WV
24901-1063
US

V. Phone/Fax

Practice location:
  • Phone: 304-645-7447
  • Fax:
Mailing address:
  • Phone: 304-645-7447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number183500000X
License Number StateWV

VIII. Authorized Official

Name: MR. NORMAN EDWARD GLASSER
Title or Position: BUSINESS MANAGER
Credential:
Phone: 304-645-1890