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General NPI Number Information
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NPI Number | 1518730852
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Entity Type | Individual
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Provider Name | MAXWELL TOD FREDRICH PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/30/2023
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Last Update Date | 01/24/2024
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Provider Practice Location Address
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Address Line | 1191 WESTOWNE DR
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City | NEENAH
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State | WI
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Zip | 54956-2176
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Country | US
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Telephone | 920-725-3152
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Fax |
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Provider Business Mailing Address
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Address Line | 1058 TIMBER RUN DR
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City | NEENAH
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State | WI
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Zip | 54956-1480
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Country | US
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Telephone | 920-574-0484
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 22501-40
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License Number State | WI
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