JERRY WALTER FREDERICK


Address: 4025 S Old State Road 37, Bloomington, IN 47401-7482
Phone: 8128245205

JERRY WALTER FREDERICK (NPI# 1033759899) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1033759899
Entity Type Individual
Full Name JERRY WALTER FREDERICK
Credential RPH
Practice Address 4025 S Old State Road 37
Bloomington
IN 47401-7482
Practice Telephone 8128245205
Practice Fax Number 8128245207
Mailing Telephone 8128245205
Enumeration Date 2020-01-09
Last Update Date 2020-01-09
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 1835P0018X Pharmacist
Specialization: Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
26012786A IN Pharmacy Service Providers

Office Location

Street Address 4025 S OLD STATE ROAD 37
City BLOOMINGTON
State IN
Zip Code 47401-7482

Providers in the same location

NPI Name Taxonomy Address Enumeration
1013080324 Kroger Limited Partnership I Pharmacy 4025 S Old State Road 37, Bloomington, IN 47401-7482 2006-11-16
1336785393 Laura Rose Jones Pharmacist 4025 S Old State Road 37, Bloomington, IN 47401-7482 2019-11-25
1245876812 Murphy O'toole Pharmacist 4025 S Old State Road 37, Bloomington, IN 47401-7482 2019-11-19

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1740765791 Holly G Carter Physical Therapist 3607 Heirloom Dr, Bloomington, IN 47401 2018-09-26
1285116657 Kimberly D Bergan Occupational Therapist 3607 S Heirloom Dr, Bloomington, IN 47401 2018-09-03
1255836813 Erin Kathleen Sain Nurse Practitioner 326 W Woodcrest Drive, Bloomington, IN 47401 2018-03-27
1881104289 Ev Bloomington Limited Partnership Assisted Living Facility 3607 South Heirloom Drive, Bloomington, IN 47401 2017-10-11
1619496536 Kirsten N Neely Physical Therapist 2604 E. Creek's Edge Dr., Bloomington, IN 47401 2017-09-12
1023533908 Hoosier United Therapy Service LLC Physical Therapist 2801 E Plateau Place, Bloomington, IN 47401 2017-08-11
1194127381 Ann Marie Neeley Lactation Consultant, Non-RN 2458 South Walnut Street, Bloomington, IN 47401 2014-09-19
1518397801 Indiana Spine and Sports Inc. Chiropractor 418 S Walnut St Suite C, Bloomington, IN 47401 2013-11-22
1053654574 William Robblee Anderson Obstetrics & Gynecology 2625 E. Spicewood Ct., Bloomington, IN 47401 2013-04-03
1285979377 Jenna Marie Dale Optometrist 322 S. Woodcrest Drive Precision Eye Group, Bloomington, IN 47401 2012-11-30
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Taxonomy Information

Taxonomy Code 1835P0018X
Grouping Pharmacy Service Providers
Classification Pharmacist
Specialization Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist

Taxonomy Definition

Pharmacist Clinician/Clinical Pharmacy Specialist is a pharmacist with additional training and an expanded scope of practice that may include prescriptive authority, therapeutic management, and disease management.
Notes: Source: National Uniform Claim Committee, 2007 [1/1/2008: new]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1235497488 Elise Anne Mccuiston Pharmacist 451 S Landmark Ave, Bloomington, IN 47403-5004 2012-04-25
1912217357 Jennifer Gale Reiter Pharmacist 1302 S. Rogers Street, Bloomington, IN 47403 2010-10-19
1609905686 Marypat Habermas Pharmacist 7349 Bush Lake Dr, Bloomington, MN 55438 2007-03-05
1073130373 Savanna Spice Pharmacist 500 S Liberty Dr, Bloomington, IN 47403-1924 2020-07-02
1326684267 Derek Brent Fields Pharmacist 601 W 2nd St Ste 100, Bloomington, IN 47403-2317 2019-11-26
1457906844 Jayna Marlene Osborne Pharmacist 601 W 2nd St, Bloomington, IN 47403-2317 2019-08-02

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1841816766 Kimberlee Chilcote Pharmacist 8275 Allison Pointe Trl Ste 370, Indianapolis, IN 46250-4298 2020-06-17
1700413721 Damar Pharmacy Services LLC Pharmacist 5715 Decatur Blvd, Indianapolis, IN 46241-9561 2020-03-27
1871123562 Kathy Jo Passereni Pharmacist 1541 Tipton St, Seymour, IN 47274 2020-01-22
1811537095 Marla Ann Carroll Pharmacist 815 Highlander Point Drive, Floyds Knobs, IN 47119 2020-01-15
1508404815 Shelli Ann Bulach Pharmacist 1034 Sr 229 North, Batesville, IN 47006 2019-12-17
1235773169 Amy Epley Pharmacist 350 W Columbia St Ste 210, Evansville, IN 47710-1782 2019-11-04
1649767955 Sean Meador Pharmacist 3630 31st Street, Columbus, IN 47203 2018-04-23
1093218489 Sparkle Box Pharmacist 1908 Bluebird Ln, Munster, IN 46321-3429 2018-03-13
1194150490 Janet Redmond Pharmacist 6911 Hillsdale Ct, Indianapolis, IN 46250-2054 2013-09-05
1962751446 Robert L Plant Pharmacist 3602 New Vision Drive, Fort Wayne, IN 46845 2012-08-30
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Competitor

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City BLOOMINGTON
Zip Code 47401

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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