Healthcare Provider Details

I. General information

NPI: 1346659539
Provider Name (Legal Business Name): MRS. DONETTA FRICKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2014
Last Update Date: 08/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40130 10TH ST W
PALMDALE CA
93551-3005
US

IV. Provider business mailing address

40130 10TH ST W
PALMDALE CA
93551-3005
US

V. Phone/Fax

Practice location:
  • Phone: 661-267-6596
  • Fax: 661-267-2839
Mailing address:
  • Phone: 661-267-6596
  • Fax: 661-267-2839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number42666
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: