Provider Demographics
NPI:1942651369
Name:FRY, WARREN JR
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:
Last Name:FRY
Suffix:JR
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 1:2032 DELL RANGE BLVD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-4956
Mailing Address - Country:US
Mailing Address - Phone:307-634-7466
Mailing Address - Fax:307-634-0066
Practice Address - Street 1:2032 DELL RANGE BLVD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4956
Practice Address - Country:US
Practice Address - Phone:307-634-7466
Practice Address - Fax:307-634-0066
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1973183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist