Provider Demographics
NPI:1588852669
Name:FRY, CATHERINE ANN (RPH)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANN
Last Name:FRY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 SHERWOOD BLVD
Mailing Address - Street 2:SMITH'S FOOD AND DRUG PHARMACY
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-3730
Mailing Address - Country:US
Mailing Address - Phone:505-672-9457
Mailing Address - Fax:
Practice Address - Street 1:31 SHERWOOD BLVD
Practice Address - Street 2:SMITH'S PHARMACY
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-3730
Practice Address - Country:US
Practice Address - Phone:505-672-9457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-14
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00005167183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMRP00005167OtherNM RPH LISCENSE
OH03315842OtherOH PHARMACIST LISCENSE