Healthcare Provider Details

I. General information

NPI: 1003105131
Provider Name (Legal Business Name): MRS. FREDERICA L WINTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 TUSCARAWAS ST W
CANTON OH
44708-5619
US

IV. Provider business mailing address

7545 SEEL AVE NW
NORTH CANTON OH
44720-6444
US

V. Phone/Fax

Practice location:
  • Phone: 330-478-8129
  • Fax:
Mailing address:
  • Phone: 330-494-8807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03211368
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: