Provider Demographics
NPI:1336449941
Name:FREDERICKSEN, HANS W (RPH)
Entity type:Individual
Prefix:MR
First Name:HANS
Middle Name:W
Last Name:FREDERICKSEN
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 1:1150 BASIN ST SW
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:WA
Mailing Address - Zip Code:98823-2138
Mailing Address - Country:US
Mailing Address - Phone:509-754-3567
Mailing Address - Fax:509-754-3837
Practice Address - Street 1:1150 BASIN ST SW
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:WA
Practice Address - Zip Code:98823-2138
Practice Address - Country:US
Practice Address - Phone:509-754-3567
Practice Address - Fax:509-754-3837
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH0000163641835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy