Provider Demographics
NPI:1609068279
Name:FRAZIER, MARY ANN (RPH)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANN
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14525 MACK AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48215-2520
Mailing Address - Country:US
Mailing Address - Phone:313-881-2890
Mailing Address - Fax:313-881-3124
Practice Address - Street 1:14525 MACK AVE
Practice Address - Street 2:SUITE A
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48215-2520
Practice Address - Country:US
Practice Address - Phone:313-881-2890
Practice Address - Fax:313-881-3124
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024153183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist