Individual
MICHAEL BRUCE FREDERICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.PH.
Contact information
Practice address
305 COMMERCE DR, MULLINS, SC 29574-6241
(843) 423-9444
Mailing address
916 N POPLAR DR, SURFSIDE BEACH, SC 29575-4170
(260) 450-4303
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
35465
SC
Other
Enumeration date
01/01/2015
Last updated
01/01/2015
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