Provider Demographics
NPI:1427591825
Name:FRU, ALLYSON (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name:FRU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:NOELLE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6153 DAWSON DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-1256
Mailing Address - Country:US
Mailing Address - Phone:513-257-5114
Mailing Address - Fax:
Practice Address - Street 1:1915 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-4401
Practice Address - Country:US
Practice Address - Phone:513-420-2546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03233462183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist