Provider Demographics
NPI:1689030926
Name:TSAJU, FREDERIC (PHARMD)
Entity Type:Individual
Prefix:
First Name:FREDERIC
Middle Name:
Last Name:TSAJU
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 1:6551 FOREST HILL DR
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:TX
Mailing Address - Zip Code:76140-1205
Mailing Address - Country:US
Mailing Address - Phone:817-478-2952
Mailing Address - Fax:
Practice Address - Street 1:6551 FOREST HILL DR
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:TX
Practice Address - Zip Code:76140-1205
Practice Address - Country:US
Practice Address - Phone:817-478-2952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57470183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist