Provider Demographics
NPI:1558728899
Name:FRYE, LEE (RPH)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:
Last Name:FRYE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2129 W HOUGHTON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48629-8236
Mailing Address - Country:US
Mailing Address - Phone:989-366-6533
Mailing Address - Fax:989-366-6528
Practice Address - Street 1:2129 W HOUGHTON LAKE DR
Practice Address - Street 2:
Practice Address - City:HOUGHTON LAKE
Practice Address - State:MI
Practice Address - Zip Code:48629-8236
Practice Address - Country:US
Practice Address - Phone:989-366-6533
Practice Address - Fax:989-366-6528
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-18
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027963183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist