# FREDERIC PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Frederic Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679991236
- **Authorized official:** ANITA LUNDQUIST (PHARMACY DIRECTOR)
- **Authorized official phone:** (715) 483-0260

## Contact information

- **Practice address:** 201 OAK ST W, FREDERIC, WI 54837-8953
- **Practice address phone:** (715) 327-4208
- **Practice address fax:** (715) 327-4232
- **Mailing address:** 201 OAK ST W, FREDERIC, WI 54837-8953
- **Mailing address phone:** (715) 327-4208
- **Mailing address fax:** (715) 327-4232

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 9306-42 | WI | Yes |

## Other

- **Enumeration date:** 04/01/2014
- **Last updated:** 09/02/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2145519 | PK | — |