Healthcare Provider Details

I. General information

NPI: 1578995148
Provider Name (Legal Business Name): FREDERICK L. MUNFORD SR. RPH, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 08/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8805 JUNALUSKA TER
CLINTON MD
20735-4312
US

IV. Provider business mailing address

8805 JUNALUSKA TER
CLINTON MD
20735-4312
US

V. Phone/Fax

Practice location:
  • Phone: 240-731-5182
  • Fax: 301-297-5096
Mailing address:
  • Phone: 240-731-5182
  • Fax: 301-297-5096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number08236
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA2074
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: