Provider Demographics
NPI:1104368232
Name:FRALEY, ALISA THOMAS (RPH)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:THOMAS
Last Name:FRALEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 HEART DR
Mailing Address - Street 2:FAMILY PRACTICE PHARMACY
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-8982
Mailing Address - Country:US
Mailing Address - Phone:252-744-4680
Mailing Address - Fax:252-744-3804
Practice Address - Street 1:101 HEART DR
Practice Address - Street 2:FAMILY PRACTICE PHARMACY
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-8982
Practice Address - Country:US
Practice Address - Phone:252-744-4680
Practice Address - Fax:252-744-3804
Is Sole Proprietor?:No
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11461183500000X
GARPH021029183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist