Provider Demographics
NPI:1487474011
Name:SHULL, FREDERICK HARRINGTON JR (PHARMD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:HARRINGTON
Last Name:SHULL
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:DERICK
Other - Middle Name:
Other - Last Name:SHULL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1008 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CONNERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47331-1030
Mailing Address - Country:US
Mailing Address - Phone:702-954-0565
Mailing Address - Fax:
Practice Address - Street 1:4200 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331-3493
Practice Address - Country:US
Practice Address - Phone:765-825-7664
Practice Address - Fax:765-825-7868
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26031062A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist