Individual
LAURETTE SUSAN FRAZIER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMACIST, DSP.
Contact information
Practice address
2815 E 10TH ST, BLOOMINGTON, IN 47408-2601
(812) 679-2207
Mailing address
894 E MILLER DR, BLOOMINGTON, IN 47401-6712
(812) 679-2207
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
110997
CA
183500000X
Pharmacist
26015089A
IN
246Z00000X
Other Specialist/Technologist
Primary
197509
IN
Other
Enumeration date
01/26/2008
Last updated
11/18/2023
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