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General NPI Number Information
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NPI Number | 1841801388
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Entity Type | Individual
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Provider Name | ANDREW FRIEDLEY
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Gender | Male
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Dates
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Enumeration Date | 08/10/2020
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Last Update Date | 08/10/2020
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Provider Practice Location Address
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Address Line | 129 OLD ABE RD
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City | LAC DU FLAMBEAU
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State | WI
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Zip | 54538-9386
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Country | US
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Telephone | 715-588-3371
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Fax |
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Provider Business Mailing Address
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Address Line | 5836 REST LAKE RD
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City | MANITOWISH WATERS
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State | WI
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Zip | 54545-6394
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Country | US
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Telephone | 262-349-3073
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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 | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | 14584-40
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License Number State | WI
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