Provider Demographics
NPI:1164644076
Name:FRATAMICO, JOHN ANTHONY (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ANTHONY
Last Name:FRATAMICO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 OSPREY DRIVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-3335
Mailing Address - Country:US
Mailing Address - Phone:603-319-4649
Mailing Address - Fax:401-216-3352
Practice Address - Street 1:23 OSPREY DRIVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-3335
Practice Address - Country:US
Practice Address - Phone:603-319-4649
Practice Address - Fax:401-216-3352
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2912183500000X
NC18129183500000X
MA22545183500000X
MEPR5283183500000X
FLPS 30414183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist