Provider Demographics
NPI:1245391069
Name:FRUCHTMAN, MATTY S (RPH)
Entity Type:Individual
Prefix:
First Name:MATTY
Middle Name:S
Last Name:FRUCHTMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 GREGORY LN
Mailing Address - Street 2:
Mailing Address - City:MILLWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:10546-1039
Mailing Address - Country:US
Mailing Address - Phone:914-234-3744
Mailing Address - Fax:914-234-0652
Practice Address - Street 1:424 OLD POST RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NY
Practice Address - Zip Code:10506-1018
Practice Address - Country:US
Practice Address - Phone:914-234-3744
Practice Address - Fax:914-234-0652
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033547-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist