Provider Demographics
NPI:1285911883
Name:FREDERICK, HEATHER JOY (PHARMD RPH)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:JOY
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:PHARMD RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 N MAIZE RD
Mailing Address - Street 2:T-1945
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-7311
Mailing Address - Country:US
Mailing Address - Phone:316-721-4289
Mailing Address - Fax:
Practice Address - Street 1:2727 N MAIZE RD
Practice Address - Street 2:T-1945
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-7311
Practice Address - Country:US
Practice Address - Phone:316-721-4289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-15199183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist