Provider Demographics
NPI:1164026340
Name:FROELICH, DAVID CHARLES
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:CHARLES
Last Name:FROELICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 7TH ST S UNIT 550
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4075
Mailing Address - Country:US
Mailing Address - Phone:267-414-3676
Mailing Address - Fax:
Practice Address - Street 1:294 37TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-1416
Practice Address - Country:US
Practice Address - Phone:727-896-3166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-28
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP453033183500000X
FLPS60170183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist