Provider Demographics
NPI:1477847754
Name:FREDERICK, KRISTOPHER K (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTOPHER
Middle Name:K
Last Name:FREDERICK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 COX CREEK PKWY
Mailing Address - Street 2:T-1322
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-1540
Mailing Address - Country:US
Mailing Address - Phone:256-766-9839
Mailing Address - Fax:
Practice Address - Street 1:372 COX CREEK PKWY
Practice Address - Street 2:T-1322
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1540
Practice Address - Country:US
Practice Address - Phone:256-766-9839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-04
Last Update Date:2011-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15249183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist