MEDICARE: MR. JOHN MATHIS FRADY RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	3713	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3713	OTHER	SC	PHARMACY LICENSE NUMBER

General Provider Information

NPI Number	:	1306838024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN MATHIS FRADY RPH

Provider Business Mailing Address
First Line	:	PO BOX 817
Second Line	:	159 KASLER ROAD
City	:	COWPENS
State	:	SC
Zip	:	29330-0817
Country	:	US
Telephone Number	:	864-463-6947
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 W SAINT JOHN ST
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29306-2336
Country	:	US
Telephone Number	:	864-253-8600
Fax Number	:	864-253-8690

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	07/08/2007

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