Provider Demographics
NPI:1760707459
Name:FRYDRYCHOWSKI, ALAN (RPH)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:FRYDRYCHOWSKI
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 1:651 DICK RD
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-1821
Mailing Address - Country:US
Mailing Address - Phone:716-681-2715
Mailing Address - Fax:716-686-0630
Practice Address - Street 1:651 DICK RD
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-1821
Practice Address - Country:US
Practice Address - Phone:716-681-2715
Practice Address - Fax:716-686-0630
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051131183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist