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NPI Code Detail

MEDICARE: DR. JASON A FREDERICK PHARM.D.

MEDICARE: DR. JASON A FREDERICK PHARM.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistS018631AZ

General Provider Information

NPI Number : 1043599897
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JASON A FREDERICK PHARM.D.
Provider Business Mailing Address
First Line : 9450 W CABELA DR
Second Line : APT. 2338
City : GLENDALE
State : AZ
Zip : 85305-1304
Country : US
Telephone Number : 330-240-0162
Fax Number :
Provider Business Practice Location Address
First Line : 5011 W UNION HILLS DR
Second Line :
City : GLENDALE
State : AZ
Zip : 85308-1441
Country : US
Telephone Number : 602-896-0257
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2011
Last Update Date : 08/11/2011

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