Provider Demographics
NPI:1013028885
Name:FRIEDRICH, DELORES DIANE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DELORES
Middle Name:DIANE
Last Name:FRIEDRICH
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 1:4104 FIELDING DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-4004
Mailing Address - Country:US
Mailing Address - Phone:217-483-7431
Mailing Address - Fax:217-483-7491
Practice Address - Street 1:1053 JASON PL
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:IL
Practice Address - Zip Code:62629-2018
Practice Address - Country:US
Practice Address - Phone:217-483-7431
Practice Address - Fax:217-483-7491
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051041194183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist