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).
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 |
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 |
Street Address |
4025 S OLD STATE ROAD 37 |
City | BLOOMINGTON |
State | IN |
Zip Code | 47401-7482 |
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 |
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 |
Find all providers in zip 47401 |
Taxonomy Code | 1835P0018X |
Grouping | Pharmacy Service Providers |
Classification | Pharmacist |
Specialization | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
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] |
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 |
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 |
Find all providers with the same taxonomy |
City | BLOOMINGTON |
Zip Code | 47401 |
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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.