Provider Demographics
NPI:1417095167
Name:FRUZZA, EDWARD
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:FRUZZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 CHURN CREEK RD STE A1
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-2532
Mailing Address - Country:US
Mailing Address - Phone:530-222-3039
Mailing Address - Fax:530-222-0337
Practice Address - Street 1:3330 CHURN CREEK RD
Practice Address - Street 2:SUITE A1
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2532
Practice Address - Country:US
Practice Address - Phone:530-222-3039
Practice Address - Fax:530-222-0337
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY324920183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist