Provider Demographics
NPI:1487722070
Name:FRIESNER, JUSTIN P (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:P
Last Name:FRIESNER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1477 WYANDOTTE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-6704
Mailing Address - Country:US
Mailing Address - Phone:740-503-7191
Mailing Address - Fax:
Practice Address - Street 1:1585 GEORGESVILLE SQ
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-3777
Practice Address - Country:US
Practice Address - Phone:614-878-1664
Practice Address - Fax:614-878-1785
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-27134183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist