Provider Demographics
NPI:1558827675
Name:FREDERICK, ALEX ELIZABETH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:ELIZABETH
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:ALEX
Other - Middle Name:ELIZABETH
Other - Last Name:CRITZ-CULP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:PO BOX 5395
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:CO
Mailing Address - Zip Code:81631-5395
Mailing Address - Country:US
Mailing Address - Phone:970-409-9407
Mailing Address - Fax:
Practice Address - Street 1:1906 BLAKE AVE
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4259
Practice Address - Country:US
Practice Address - Phone:970-384-7585
Practice Address - Fax:970-384-6696
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO204871835X0200X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835X0200XPharmacy Service ProvidersPharmacistOncology