Provider Demographics
NPI:1669599890
Name:FRIS, JOHN MICHAEL (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
Last Name:FRIS
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 1:499 DUWELL ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15906-1660
Mailing Address - Country:US
Mailing Address - Phone:814-536-2656
Mailing Address - Fax:
Practice Address - Street 1:499 DUWELL ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15906-1660
Practice Address - Country:US
Practice Address - Phone:814-536-2656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP026106L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist