Individual
JONATHAN FRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
2140 N PEORIA RD, SPRINGFIELD, IL 62702-1840
(217) 544-2925
Mailing address
70 AXLINE RD, CHATHAM, IL 62629-1574
(630) 873-5922
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051292483
IL
Other
Enumeration date
09/22/2011
Last updated
09/22/2011
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