Provider Demographics
NPI:1982939948
Name:HIRTH, FREDERICK ALAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:ALAN
Last Name:HIRTH
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 1:4323 W LAPENNA DR
Mailing Address - Street 2:
Mailing Address - City:NEW RIVER
Mailing Address - State:AZ
Mailing Address - Zip Code:85087-4905
Mailing Address - Country:US
Mailing Address - Phone:623-505-3738
Mailing Address - Fax:
Practice Address - Street 1:39508 N DAISY MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-6056
Practice Address - Country:US
Practice Address - Phone:623-551-7221
Practice Address - Fax:623-551-7220
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS008910183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist