Provider Demographics
NPI:1679048136
Name:FREDERICK, CRAIG A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:A
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:PO BOX 224
Mailing Address - Street 2:
Mailing Address - City:GUERNSEY
Mailing Address - State:WY
Mailing Address - Zip Code:82214-0224
Mailing Address - Country:US
Mailing Address - Phone:307-331-0371
Mailing Address - Fax:307-836-9275
Practice Address - Street 1:437 WEST WHALEN ST
Practice Address - Street 2:
Practice Address - City:GUERNSEY
Practice Address - State:WY
Practice Address - Zip Code:82214-0250
Practice Address - Country:US
Practice Address - Phone:307-836-9270
Practice Address - Fax:307-836-9275
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2863183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist