Healthcare Provider Details

I. General information

NPI: 1487904942
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL FRAZER PHARMD, BCACP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2012
Last Update Date: 12/01/2024
Certification Date: 12/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 TOWER AVE STE A
SUPERIOR WI
54880-4685
US

IV. Provider business mailing address

211 MAPLE GROVE RD
DULUTH MN
55811-4726
US

V. Phone/Fax

Practice location:
  • Phone: 715-817-7880
  • Fax:
Mailing address:
  • Phone: 218-310-6217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number16780-40
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number5302042469
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number126756
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number16780-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: