Individual
MARY FRYE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
110 S 17TH AVE, WAUSAU, WI 54401-4227
(715) 848-9066
Mailing address
110 S 17TH AVE, WAUSAU, WI 54401-4227
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
1485940
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33275000
—
WI
Enumeration date
02/27/2013
Last updated
02/27/2013
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