Provider Demographics
NPI:1205201662
Name:FRYS FOOD AND DRGS
Entity Type:Organization
Organization Name:FRYS FOOD AND DRGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DISTRICT COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAANE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:602-818-5260
Mailing Address - Street 1:1845 E BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-1545
Mailing Address - Country:US
Mailing Address - Phone:480-539-3733
Mailing Address - Fax:
Practice Address - Street 1:1845 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-1545
Practice Address - Country:US
Practice Address - Phone:480-539-3733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ009999333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy