Provider Demographics
NPI:1104226331
Name:FRERICHS, SUSANNE JOYCE (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:SUSANNE
Middle Name:JOYCE
Last Name:FRERICHS
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:SUSANNE
Other - Middle Name:JOYCE
Other - Last Name:TROYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2101 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:NEBRASKA CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68410-3481
Mailing Address - Country:US
Mailing Address - Phone:402-874-9093
Mailing Address - Fax:402-874-9098
Practice Address - Street 1:2101 S 11TH ST
Practice Address - Street 2:
Practice Address - City:NEBRASKA CITY
Practice Address - State:NE
Practice Address - Zip Code:68410-3481
Practice Address - Country:US
Practice Address - Phone:402-874-9093
Practice Address - Fax:402-874-9098
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13950183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist