Provider Demographics
NPI:1598062234
Name:FRUIN, DENNIS (RPH)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:
Last Name:FRUIN
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 1:2929 S WABASH AVE
Mailing Address - Street 2:#101
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-3243
Mailing Address - Country:US
Mailing Address - Phone:312-791-3334
Mailing Address - Fax:
Practice Address - Street 1:2929 S WABASH AVE
Practice Address - Street 2:#101
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-3243
Practice Address - Country:US
Practice Address - Phone:312-791-3334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051030963183500000X
NE12445183500000X
CA30787183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist