Provider Demographics
NPI:1023390929
Name:CARODINE, FREDERICK G JR
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:G
Last Name:CARODINE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 HUNTSVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-3442
Mailing Address - Country:US
Mailing Address - Phone:931-433-5569
Mailing Address - Fax:931-433-8671
Practice Address - Street 1:1000 HUNTSVILLE HWY
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-3442
Practice Address - Country:US
Practice Address - Phone:931-433-5569
Practice Address - Fax:931-433-8671
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11660183500000X
TN26683183500000X
AL15489183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist