Provider Demographics
NPI:1225741085
Name:FRAZEE, GARY DAVID
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:DAVID
Last Name:FRAZEE
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 1:5710 YOUNG PINE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32829-7400
Mailing Address - Country:US
Mailing Address - Phone:407-310-7188
Mailing Address - Fax:
Practice Address - Street 1:5710 YOUNG PINE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32829-7400
Practice Address - Country:US
Practice Address - Phone:407-310-7188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-26
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS23425183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist