Provider Demographics
NPI:1609479401
Name:FRY, JEREMY MICHAEL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:MICHAEL
Last Name:FRY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 TIFFIN AVE
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-5757
Mailing Address - Country:US
Mailing Address - Phone:419-423-3236
Mailing Address - Fax:
Practice Address - Street 1:463 TIFFIN AVE
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-5757
Practice Address - Country:US
Practice Address - Phone:419-423-3236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03328545183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist