Provider Demographics
NPI:1740565258
Name:FREY, PATRICK J
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:J
Last Name:FREY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 SOUTH RIVER ST
Mailing Address - Street 2:COSTCO PHARMACY 231
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-6954
Mailing Address - Country:US
Mailing Address - Phone:201-487-9671
Mailing Address - Fax:201-487-9675
Practice Address - Street 1:80 SOUTH RIVER ST
Practice Address - Street 2:COSTCO PHARMACY 231
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:09601-6954
Practice Address - Country:US
Practice Address - Phone:201-487-9671
Practice Address - Fax:201-487-9675
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-15
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01852100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist