Provider Demographics
NPI:1619366648
Name:FRATES, GEORGE ANTHONY IV (PHARM D)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:ANTHONY
Last Name:FRATES
Suffix:IV
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2498 N. PLEASANTBURG DR.
Mailing Address - Street 2:SWEATGRASS PHARMACY
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:660 HALTON RD
Practice Address - Street 2:APT 8G
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3437
Practice Address - Country:US
Practice Address - Phone:864-236-4350
Practice Address - Fax:864-236-4360
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35724183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC35724OtherPHARMACIST LICENSE