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NPI Code Detail

MEDICARE: JEFFREY NEAL FRYE

MEDICARE:   JEFFREY NEAL FRYE
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
1183500000XPharmacist15015IA

General Provider Information

NPI Number : 1760767503
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY NEAL FRYE
Provider Business Mailing Address
First Line : 2503 5TH AVE S
Second Line :
City : FORT DODGE
State : IA
Zip : 50501-5552
Country : US
Telephone Number : 515-576-7113
Fax Number : 515-576-5782
Provider Business Practice Location Address
First Line : 2503 5TH AVE S
Second Line :
City : FORT DODGE
State : IA
Zip : 50501-5552
Country : US
Telephone Number : 515-576-7113
Fax Number : 515-576-5782
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2011
Last Update Date : 10/12/2011

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Directions to “ JEFFREY NEAL FRYE ” Practice Location

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