Provider Demographics
NPI:1609198282
Name:FRIED, JEFFREY M (RPH)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:FRIED
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 1:2823 NOSTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1816
Mailing Address - Country:US
Mailing Address - Phone:718-252-2818
Mailing Address - Fax:718-252-4611
Practice Address - Street 1:2823 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1816
Practice Address - Country:US
Practice Address - Phone:718-252-2818
Practice Address - Fax:718-252-4611
Is Sole Proprietor?:No
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY32486183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist