Healthcare Provider Details

I. General information

NPI: 1225191224
Provider Name (Legal Business Name): FRITZ S PHARMACY AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 10/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 SENECA TRL
RONCEVERTE WV
24970-1340
US

IV. Provider business mailing address

370 SENECA TRL
RONCEVERTE WV
24970-1340
US

V. Phone/Fax

Practice location:
  • Phone: 304-645-1890
  • Fax: 304-645-6246
Mailing address:
  • Phone: 304-645-1890
  • Fax: 304-645-6246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberSP0552293
License Number StateWV

VIII. Authorized Official

Name: MR. MARK CUNNINGHAM
Title or Position: OFFICE MANAGER TREASURER
Credential: ACCOUNTANT
Phone: 304-645-6245