Provider Demographics
NPI:1114147568
Name:FRISBIE, HENRIETTE ESTELLE (RPH)
Entity Type:Individual
Prefix:
First Name:HENRIETTE
Middle Name:ESTELLE
Last Name:FRISBIE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2669 CANOE ST
Mailing Address - Street 2:
Mailing Address - City:COPPEROPOLIS
Mailing Address - State:CA
Mailing Address - Zip Code:95228-9536
Mailing Address - Country:US
Mailing Address - Phone:209-785-5206
Mailing Address - Fax:209-357-8172
Practice Address - Street 1:1701 BELLEVUE RD
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301
Practice Address - Country:US
Practice Address - Phone:209-357-2957
Practice Address - Fax:209-357-8172
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 24065183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist