MEDICARE: CATHERINE ANN FRY 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	RP00005167	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RP00005167	OTHER	NM	NM RPH LISCENSE
2	03315842	OTHER	OH	OH PHARMACIST LISCENSE

General Provider Information

NPI Number	:	1588852669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE ANN FRY RPH

Provider Business Mailing Address
First Line	:	31 SHERWOOD BLVD
Second Line	:	SMITH'S FOOD AND DRUG PHARMACY
City	:	LOS ALAMOS
State	:	NM
Zip	:	87544-3730
Country	:	US
Telephone Number	:	505-672-9457
Fax Number	:

Provider Business Practice Location Address
First Line	:	31 SHERWOOD BLVD
Second Line	:	SMITH'S PHARMACY
City	:	LOS ALAMOS
State	:	NM
Zip	:	87544-3730
Country	:	US
Telephone Number	:	505-672-9457
Fax Number	:

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

Provider Enumeration Date	:	10/14/2007
Last Update Date	:	09/20/2010

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Directions to “ CATHERINE ANN FRY RPH” Practice Location

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