Healthcare Provider Details

I. General information

NPI: 1285749473
Provider Name (Legal Business Name): FREDERICK & SMITH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 LIBERTY RD
WEST LIBERTY KY
41472-2049
US

IV. Provider business mailing address

PO BOX 277
WEST LIBERTY KY
41472-0277
US

V. Phone/Fax

Practice location:
  • Phone: 606-743-4957
  • Fax: 606-743-2187
Mailing address:
  • Phone: 606-743-4957
  • Fax: 606-743-2187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP02110
License Number StateKY

VIII. Authorized Official

Name: JAMES FREDERICK
Title or Position: OWNER,AO
Credential: RPH
Phone: 606-743-3114