Provider Demographics
NPI:1568467348
Name:FRAZIER, MARK HENRY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:HENRY
Last Name:FRAZIER
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 1:2805 KICKBUSH DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-7103
Mailing Address - Country:US
Mailing Address - Phone:219-310-4062
Mailing Address - Fax:
Practice Address - Street 1:1903 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2703
Practice Address - Country:US
Practice Address - Phone:219-462-6172
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021400A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist