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General NPI Number Information
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NPI Number | 1609053289
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Entity Type | Individual
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Provider Name | LAURETTE SUSAN FRAZIER PHARMACIST, DSP.
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Gender | Female
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Dates
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Enumeration Date | 01/26/2008
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Last Update Date | 11/18/2023
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Provider Practice Location Address
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Address Line | 2815 E 10TH ST
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City | BLOOMINGTON
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State | IN
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Zip | 47408-2601
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Country | US
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Telephone | 812-679-2207
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Fax |
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Provider Business Mailing Address
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Address Line | 894 E MILLER DR
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City | BLOOMINGTON
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State | IN
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Zip | 47401-6712
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Country | US
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Telephone | 812-679-2207
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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 | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number | 110997
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License Number State | CA
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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 | 26015089A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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License Number | 197509
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License Number State | IN
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