Provider Demographics
NPI:1205187960
Name:FRIED, IRA GARY (RPH)
Entity Type:Individual
Prefix:MR
First Name:IRA
Middle Name:GARY
Last Name:FRIED
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 1:666 ARTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-2807
Mailing Address - Country:US
Mailing Address - Phone:215-673-1695
Mailing Address - Fax:215-364-1792
Practice Address - Street 1:2 E STREET RD
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-7603
Practice Address - Country:US
Practice Address - Phone:215-364-8770
Practice Address - Fax:215-364-1792
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP028967L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP028967LOtherPENNA STATE BOARD OF PHARMACY