Provider Demographics
NPI:1083293922
Name:FRICKS PHARMACY LLC
Entity Type:Organization
Organization Name:FRICKS PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:JADE
Authorized Official - Last Name:FRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-665-4657
Mailing Address - Street 1:6472 HIGHWAY 90 UNIT B
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-4526
Mailing Address - Country:US
Mailing Address - Phone:850-665-4657
Mailing Address - Fax:850-665-4670
Practice Address - Street 1:6472 HIGHWAY 90 UNIT B
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-4526
Practice Address - Country:US
Practice Address - Phone:850-665-4657
Practice Address - Fax:850-665-4670
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRICKS PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy