Provider Demographics
NPI:1821377144
Name:LOVELACE, FREDRIC GUY (DPH)
Entity Type:Individual
Prefix:
First Name:FREDRIC
Middle Name:GUY
Last Name:LOVELACE
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34693 HIGHWAY 72 N
Mailing Address - Street 2:
Mailing Address - City:LOUDON
Mailing Address - State:TN
Mailing Address - Zip Code:37774-5242
Mailing Address - Country:US
Mailing Address - Phone:865-458-5606
Mailing Address - Fax:865-458-9241
Practice Address - Street 1:2111 HIGHWAY 72 N
Practice Address - Street 2:
Practice Address - City:LOUDON
Practice Address - State:TN
Practice Address - Zip Code:37774-5719
Practice Address - Country:US
Practice Address - Phone:865-458-6241
Practice Address - Fax:865-458-9241
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC1732183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist