Provider Demographics
NPI:1114159035
Name:FRICK, ROGER ZANE (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:ZANE
Last Name:FRICK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 W DEKALB ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-2158
Mailing Address - Country:US
Mailing Address - Phone:803-425-9527
Mailing Address - Fax:803-425-9188
Practice Address - Street 1:2209 W DEKALB ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-2158
Practice Address - Country:US
Practice Address - Phone:803-425-9527
Practice Address - Fax:803-425-9188
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6176183500000X
NC9956183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist