Provider Demographics
NPI:1073890851
Name:FREDERICK, JOHN M (PHARM D)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:FREDERICK
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 CROSSINGS LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-8547
Mailing Address - Country:US
Mailing Address - Phone:615-758-7250
Mailing Address - Fax:615-758-7281
Practice Address - Street 1:206 CROSSINGS LN
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-8547
Practice Address - Country:US
Practice Address - Phone:615-758-7250
Practice Address - Fax:615-758-7281
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22137183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist