Provider Demographics
NPI:1467962415
Name:FREDRICKS, SARAH MARIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:MARIE
Last Name:FREDRICKS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5531 28TH ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-2053
Mailing Address - Country:US
Mailing Address - Phone:616-954-6010
Mailing Address - Fax:
Practice Address - Street 1:5531 28TH ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-2053
Practice Address - Country:US
Practice Address - Phone:616-954-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-04
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302041939183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist