Individual
CARLY FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
27155 W EAMES ST, CHANNAHON, IL 60410-5377
(815) 521-0326
Mailing address
27155 W EAMES ST, CHANNAHON, IL 60410-5377
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051.293345
IL
Other
Enumeration date
08/31/2011
Last updated
08/31/2011
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