Individual
MR. TERRY ALLEN FREDERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1801 MAIN ST, JEANERETTE, LA 70544-3423
(337) 276-4101
Mailing address
1801 MAIN ST, JEANERETTE, LA 70544-3423
(337) 276-4101
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
10346
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1207624
—
LA
01
—
1906241
NABP NUMBER
LA
Enumeration date
02/26/2007
Last updated
07/08/2007
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