Provider Demographics
NPI:1114359783
Name:FRITZ'S PHARMACY, INC.
Entity Type:Organization
Organization Name:FRITZ'S PHARMACY, INC.
Other - Org Name:FRITZ'S PHARMACY III
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-645-1890
Mailing Address - Street 1:499 KANAWHA AVE
Mailing Address - Street 2:
Mailing Address - City:RAINELLE
Mailing Address - State:WV
Mailing Address - Zip Code:25962-1045
Mailing Address - Country:US
Mailing Address - Phone:304-438-8500
Mailing Address - Fax:304-438-8501
Practice Address - Street 1:499 KANAWHA AVE
Practice Address - Street 2:
Practice Address - City:RAINELLE
Practice Address - State:WV
Practice Address - Zip Code:25962-1045
Practice Address - Country:US
Practice Address - Phone:304-438-8500
Practice Address - Fax:304-438-8501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-05
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVMP0552407OtherSTATE PHARMACY LICENSE