Organization
FREDS PHARMACY LLC
Active
Other names
Freds Granville Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
FREDERICK DOLTZ (OWNER/SUPERVISING PHARMACIST)
(518) 642-3733
Entity
Organization
Contact information
Practice address
75 QUAKER STREET, GRANVILLE, NY 12832
(518) 642-3733
Mailing address
75 QUAKER STREET, GRANVILLE, NY 12832
(518) 642-3733
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
033911
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2153978
PK
—
Enumeration date
09/11/2015
Last updated
09/11/2015
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