Provider Demographics
NPI:1164107181
Name:FRYFOGLE, ERIN ELISABETH BRADLEY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:ELISABETH BRADLEY
Last Name:FRYFOGLE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MAGGIES PT
Mailing Address - Street 2:
Mailing Address - City:LEAKESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39451-3152
Mailing Address - Country:US
Mailing Address - Phone:601-394-8601
Mailing Address - Fax:
Practice Address - Street 1:1017 HIGHWAY 57
Practice Address - Street 2:
Practice Address - City:LEAKESVILLE
Practice Address - State:MS
Practice Address - Zip Code:39451-5807
Practice Address - Country:US
Practice Address - Phone:601-394-4720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-101139183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist