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General NPI Number Information
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NPI Number | 1740834126
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Entity Type | Individual
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Provider Name | KRYSTAL L FRERICHS PHARMD
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Gender | Female
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Dates
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Enumeration Date | 07/24/2019
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Last Update Date | 07/24/2019
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Provider Practice Location Address
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Address Line | 845 BROADMEADOW RD
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City | RANTOUL
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State | IL
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Zip | 61866-2119
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Country | US
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Telephone | 217-892-9171
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Fax | 217-892-9565
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Provider Business Mailing Address
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Address Line | 2642 COUNTY ROAD 2900 N
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City | PENFIELD
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State | IL
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Zip | 61862-9734
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Country | US
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Telephone |
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051.295080
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License Number State | IL
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