Active NPI
Richard P Frederickson02/
- Pharmacist
- Mandeville, LA
National Provider Identifier
1023390168
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 11041
- Practice address
- 4540 Highway 22
Mandeville, LA 70471-3300 - Phone
- (985) 674-3320
- NPI assigned
- Sep 14, 2011
- Last updated
- Sep 14, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 11041 | LA | Primary |
Addresses
Primary practice location
4540 Highway 22
Mandeville, LA 70471-3300
Mailing address
4540 Highway 22
Mandeville, LA 70471-3300
Phone (985) 674-3320
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11041 | LA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Louisiana CVS Pharmacy LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1315958400000",
"number": "1023390168",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4540 HIGHWAY 22",
"city": "MANDEVILLE",
"state": "LA",
"postal_code": "704713300",
"telephone_number": "985-674-3320"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4540 HIGHWAY 22",
"city": "MANDEVILLE",
"state": "LA",
"postal_code": "704713300",
"telephone_number": "985-674-3320"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREDERICKSON02/",
"first_name": "RICHARD",
"middle_name": "P",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-09-14",
"last_updated": "2011-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "LA",
"license": "11041",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mandeville, LA
- Fphsa Fontainebleau Treatment Center
- Fphsa Northlake Addictive Disorders Clinic
- Kelley Lynne Francis, PHD
- Arthur J. Franz III, O.D.
- Fred a. Miller, DC, LLC (Doctors Chiropractic Group)
- Carol Freeman, PHD
- Tara Freeman, BCBA
- Charlotte Michelle Fuller, APRN
- Larkin Ellison Fultz, LCSW
- Fussell Health, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.