Provider Demographics
NPI:1699072728
Name:FREDERICK, ALAN J (RPH)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:J
Last Name:FREDERICK
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 1:1500 CHARLESTON HWY
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-5048
Mailing Address - Country:US
Mailing Address - Phone:803-796-3722
Mailing Address - Fax:
Practice Address - Street 1:1500 CHARLESTON HWY
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-5048
Practice Address - Country:US
Practice Address - Phone:803-796-3722
Practice Address - Fax:847-396-2819
Is Sole Proprietor?:No
Enumeration Date:2011-02-25
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8757183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist