Healthcare Provider Details

I. General information

NPI: 1912459694
Provider Name (Legal Business Name): TUESDAY YVONNE FREDRICKS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2016
Last Update Date: 10/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 26TH AVE E
BRADENTON FL
34208-7707
US

IV. Provider business mailing address

6618 49TH CT E
ELLENTON FL
34222-4037
US

V. Phone/Fax

Practice location:
  • Phone: 941-713-4577
  • Fax: 941-708-8517
Mailing address:
  • Phone: 813-376-3299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS30594
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: