Provider Demographics
NPI:1538151980
Name:FRY, CLAIRE MALONSON (RPH BCPP)
Entity type:Individual
Prefix:MS
First Name:CLAIRE
Middle Name:MALONSON
Last Name:FRY
Suffix:
Gender:F
Credentials:RPH BCPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 BRAEMER CT
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-2003
Mailing Address - Country:US
Mailing Address - Phone:707-747-6552
Mailing Address - Fax:707-253-5766
Practice Address - Street 1:2100 NAPA VALLEJO HWY
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6234
Practice Address - Country:US
Practice Address - Phone:707-253-5367
Practice Address - Fax:707-253-5766
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA453121835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric