Healthcare Provider Details

I. General information

NPI: 1033607817
Provider Name (Legal Business Name): FREDERIQUE DUNHAM PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 S MARION AVE
LAKE CITY FL
32025-5808
US

IV. Provider business mailing address

287 NE 108TH LN
BRANFORD FL
32008-6982
US

V. Phone/Fax

Practice location:
  • Phone: 386-755-3016
  • Fax:
Mailing address:
  • Phone: 352-275-8526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS58337
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: