Provider Demographics
NPI:1912453275
Name:FRY, CATHERINE A (CPHT)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:FRY
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:A
Other - Last Name:FRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPHT
Mailing Address - Street 1:1776 SW MADISON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1715
Mailing Address - Country:US
Mailing Address - Phone:503-224-1044
Mailing Address - Fax:503-621-2235
Practice Address - Street 1:703 NE HANCOCK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3955
Practice Address - Country:US
Practice Address - Phone:503-230-9875
Practice Address - Fax:503-331-2677
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCPT-0004520183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORCPT 0004520OtherPHARMACY TECHNICIAN