Provider Demographics
NPI:1831533850
Name:FREDERICK, CHRISTOPHER L (RPH)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:L
Last Name:FREDERICK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5707 HAMILTON LEBANON RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-9284
Mailing Address - Country:US
Mailing Address - Phone:513-465-6636
Mailing Address - Fax:
Practice Address - Street 1:4090 E GALBRAITH RD
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:OH
Practice Address - Zip Code:45236-2324
Practice Address - Country:US
Practice Address - Phone:513-891-2808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-21
Last Update Date:2013-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-21834183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist