Provider Demographics
NPI:1336325000
Name:FRY, REBECCA L (RPH (BS))
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:L
Last Name:FRY
Suffix:
Gender:F
Credentials:RPH (BS)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 GRANVILLE CT
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-2575
Mailing Address - Country:US
Mailing Address - Phone:443-691-2435
Mailing Address - Fax:
Practice Address - Street 1:15 W BEL AIR AVE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-3234
Practice Address - Country:US
Practice Address - Phone:410-534-8656
Practice Address - Fax:410-272-1122
Is Sole Proprietor?:No
Enumeration Date:2008-01-12
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15016183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist