Provider Demographics
NPI:1023672144
Name:FRY, MARY JANE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:JANE
Last Name:FRY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11101 HEFNER POINTE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-5054
Mailing Address - Country:US
Mailing Address - Phone:405-755-3921
Mailing Address - Fax:405-755-3922
Practice Address - Street 1:11101 HEFNER POINTE DR STE 101
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-5054
Practice Address - Country:US
Practice Address - Phone:405-755-3921
Practice Address - Fax:405-755-3922
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10463183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist