Provider Demographics
NPI:1568746667
Name:FRATEZI, ELISABETH C
Entity Type:Individual
Prefix:MR
First Name:ELISABETH
Middle Name:C
Last Name:FRATEZI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 BRODHEAD ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-1647
Mailing Address - Country:US
Mailing Address - Phone:610-250-7163
Mailing Address - Fax:
Practice Address - Street 1:1955 SULLIVAN TRL
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18040-8383
Practice Address - Country:US
Practice Address - Phone:610-258-7439
Practice Address - Fax:610-258-7516
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP038643R183500000X
NJ28RI02086900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist