Basic Information
| Provider Information | |||||||||
| NPI: | 1922478254 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRY | ||||||||
| FirstName: | CHRISTIAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9212 N COLTON ST | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992181284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094642736 | ||||||||
| FaxNumber: | 5094644692 | ||||||||
| Practice Location | |||||||||
| Address1: | 9212 N COLTON ST | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992181284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094642736 | ||||||||
| FaxNumber: | 5094644692 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2015 | ||||||||
| LastUpdateDate: | 09/29/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PH60557648 | WA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.