Provider Demographics
NPI:1215575964
Name:FRAZIER, JILL MADONIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MADONIA
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 COFFEE POT LN
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-1624
Mailing Address - Country:US
Mailing Address - Phone:501-454-2159
Mailing Address - Fax:
Practice Address - Street 1:2 COFFEE POT LN
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-1624
Practice Address - Country:US
Practice Address - Phone:501-454-2159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR80451835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty