Individual
JAY E FREDERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
3320 S 23RD ST, TACOMA, WA 98405-1603
(253) 414-0303
Mailing address
3320 S 23RD ST, TARGET STORE- 0341, TACOMA, WA 98405-1603
(253) 414-0303
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PH00061169
WA
Other
Enumeration date
07/05/2011
Last updated
07/05/2011
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