Individual
LARRY ALAN FREDERICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
242 N OAKLAND AVE, NAPPANEE, IN 46550-2319
(574) 773-7873
(574) 773-3673
Mailing address
3 MEADOW LN, NAPPANEE, IN 46550-1152
(574) 221-1029
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
26013548A
IN
Other
Enumeration date
12/28/2020
Last updated
12/28/2020
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