Provider Demographics
NPI:1790087351
Name:FRALEY, PHILIP (RPH)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:FRALEY
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 1:364 ROUTE 202
Mailing Address - Street 2:A-5
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-1261
Mailing Address - Country:US
Mailing Address - Phone:610-358-0110
Mailing Address - Fax:610-358-0550
Practice Address - Street 1:364 ROUTE 202
Practice Address - Street 2:A-5
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1261
Practice Address - Country:US
Practice Address - Phone:610-358-0110
Practice Address - Fax:610-358-0550
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP029472L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist