Individual
MARK R FREDERIKSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.PH.
Contact information
Practice address
2935 NEW PINERY RD, PORTAGE, WI 53901-9226
(608) 742-3886
Mailing address
2935 NEW PINERY RD, PORTAGE, WI 53901-9226
(608) 742-3886
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
10269
WI
Other
Enumeration date
07/19/2012
Last updated
07/19/2012
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