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General NPI Number Information
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NPI Number | 1679991236
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Entity Type | Organization
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Legal Business Name | FREDERIC PHARMACY LLC
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Dates
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Enumeration Date | 04/01/2014
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Last Update Date | 09/02/2016
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Provider Practice Location Address
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Address Line | 201 OAK ST W
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City | FREDERIC
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State | WI
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Zip | 54837-8953
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Country | US
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Telephone | 715-327-4208
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Fax | 715-327-4232
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Provider Business Mailing Address
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Address Line | 201 OAK ST W
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City | FREDERIC
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State | WI
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Zip | 54837-8953
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Country | US
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Telephone | 715-327-4208
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Fax | 715-327-4232
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Authorized Official
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Title or Position | PHARMACY DIRECTOR
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Name | ANITA LUNDQUIST
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Credential |
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Telephone | 715-483-0260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 9306-42
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License Number State | WI
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