Provider Demographics
NPI:1083226690
Name:FRIEDLY, AUSTIN JAMES (STUDENT PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:AUSTIN
Middle Name:JAMES
Last Name:FRIEDLY
Suffix:
Gender:M
Credentials:STUDENT PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16921 N MAYFAIR DR
Mailing Address - Street 2:
Mailing Address - City:COLBERT
Mailing Address - State:WA
Mailing Address - Zip Code:99005-9292
Mailing Address - Country:US
Mailing Address - Phone:509-481-7498
Mailing Address - Fax:
Practice Address - Street 1:11 E H ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:WA
Practice Address - Zip Code:99006-7130
Practice Address - Country:US
Practice Address - Phone:509-368-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program