Individual
JERRY WALTER FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
4025 S OLD STATE ROAD 37, BLOOMINGTON, IN 47401-7482
(812) 824-5205
(812) 824-5207
Mailing address
4025 S OLD STATE ROAD 37, BLOOMINGTON, IN 47401-7482
(812) 824-5205
Taxonomy
Speciality
Code
Description
License number
State
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
26012786A
IN
Other
Enumeration date
01/09/2020
Last updated
01/09/2020
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