Provider Demographics
NPI:1982761318
Name:FRISCH, GARY H (RPH, BSPHARM)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:H
Last Name:FRISCH
Suffix:
Gender:M
Credentials:RPH, BSPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2454 W FLETCHER ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-7916
Mailing Address - Country:US
Mailing Address - Phone:773-388-2464
Mailing Address - Fax:
Practice Address - Street 1:2746 N CLYBOURN AVE
Practice Address - Street 2:COSTCO PHARMACY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1006
Practice Address - Country:US
Practice Address - Phone:773-360-2052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-029989183500000X
IL0510299891835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist