Provider Demographics
NPI:1952494775
Name:FREDRIKS, DEAN A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:A
Last Name:FREDRIKS
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 1:1017 STONEYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-4179
Mailing Address - Country:US
Mailing Address - Phone:510-625-2313
Mailing Address - Fax:510-625-3307
Practice Address - Street 1:1017 STONEYBROOK DR
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4179
Practice Address - Country:US
Practice Address - Phone:510-625-2313
Practice Address - Fax:510-625-3307
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH41939183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist