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General NPI Number Information
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NPI Number | 1205306370
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Entity Type | Individual
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Provider Name | MARK FONDRIEST RPH, DPLA
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Gender | Male
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Dates
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Enumeration Date | 11/30/2018
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Last Update Date | 11/30/2018
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Provider Practice Location Address
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Address Line | 44 BLAINE AVE
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City | BEDFORD
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State | OH
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Zip | 44146-2709
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Country | US
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Telephone | 440-735-3595
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Fax |
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Provider Business Mailing Address
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Address Line | 3821 PINWOOD CIR
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City | NORTON
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State | OH
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Zip | 44203-9505
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Country | US
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Telephone | 614-314-2356
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 03223754
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License Number State | OH
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