Provider Demographics
NPI:1700945227
Name:FRY TOVAR INC
Entity Type:Organization
Organization Name:FRY TOVAR INC
Other - Org Name:SMALL FRY'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGORIA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:956-423-1200
Mailing Address - Street 1:321 S 21ST ST
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-7430
Mailing Address - Country:US
Mailing Address - Phone:956-423-1200
Mailing Address - Fax:956-423-1063
Practice Address - Street 1:321 S 21ST ST
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-7430
Practice Address - Country:US
Practice Address - Phone:956-423-1200
Practice Address - Fax:956-423-1063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30250183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4519077OtherNABP
TX146535305Medicaid
TX146535304Medicaid
TX146535301Medicaid
TX146535302Medicaid
TX146535305Medicaid