Provider Demographics
NPI:1912459694
Name:FREDRICKS, TUESDAY YVONNE (RPH)
Entity Type:Individual
Prefix:
First Name:TUESDAY
Middle Name:YVONNE
Last Name:FREDRICKS
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 1:6618 49TH CT E
Mailing Address - Street 2:
Mailing Address - City:ELLENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34222-4037
Mailing Address - Country:US
Mailing Address - Phone:813-376-3299
Mailing Address - Fax:
Practice Address - Street 1:1505 26TH AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-7707
Practice Address - Country:US
Practice Address - Phone:941-713-4577
Practice Address - Fax:941-708-8517
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS30594183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist