Provider Demographics
NPI:1104115997
Name:FRIZZELL, MILTON DALE (RPH)
Entity type:Individual
Prefix:MR
First Name:MILTON
Middle Name:DALE
Last Name:FRIZZELL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-8703
Mailing Address - Country:US
Mailing Address - Phone:270-753-3580
Mailing Address - Fax:
Practice Address - Street 1:1502 S 12TH ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-8703
Practice Address - Country:US
Practice Address - Phone:270-753-3580
Practice Address - Fax:270-753-8304
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9025183500000X
AL9792183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist