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NPI Code Detail

MEDICARE: MR. GARY H FRISCH RPH, BSPHARM

MEDICARE: MR. GARY H FRISCH RPH, BSPHARM
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
1183500000XPharmacist051-029989IL
21835P0018XPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist051029989IL

General Provider Information

NPI Number : 1982761318
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GARY H FRISCH RPH, BSPHARM
Provider Business Mailing Address
First Line : 2454 W FLETCHER ST
Second Line :
City : CHICAGO
State : IL
Zip : 60618-7916
Country : US
Telephone Number : 773-388-2464
Fax Number :
Provider Business Practice Location Address
First Line : 2746 N CLYBOURN AVE
Second Line : COSTCO PHARMACY
City : CHICAGO
State : IL
Zip : 60614-1006
Country : US
Telephone Number : 773-360-2052
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2007
Last Update Date : 02/18/2016

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