Provider Demographics
NPI:1407069115
Name:FRITZS PHARMACY INC
Entity Type:Organization
Organization Name:FRITZS PHARMACY INC
Other - Org Name:FRITZ'S PHARMACY IV
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-645-1890
Mailing Address - Street 1:PO BOX 1063
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-4063
Mailing Address - Country:US
Mailing Address - Phone:304-645-1890
Mailing Address - Fax:866-645-0321
Practice Address - Street 1:105 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:ALDERSON
Practice Address - State:WV
Practice Address - Zip Code:24910-7000
Practice Address - Country:US
Practice Address - Phone:304-445-2956
Practice Address - Fax:304-445-2417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSP05524673336C0003X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2145521OtherPK
WV0138985000Medicaid
WV5101210001Medicare NSC