Provider Demographics
NPI:1831467877
Name:MIRSCH, FREDRIC (RPH)
Entity Type:Individual
Prefix:MR
First Name:FREDRIC
Middle Name:
Last Name:MIRSCH
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 1:2014 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-2305
Mailing Address - Country:US
Mailing Address - Phone:215-551-3818
Mailing Address - Fax:
Practice Address - Street 1:2014 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19145-2305
Practice Address - Country:US
Practice Address - Phone:215-551-3818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP033074L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist