Jerry Walter Frederick, RPH

Primary specialty

Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X

License

26012786A Issued in IN

Practice address

4025 S Old State Road 37
Bloomington, IN 47401-7482

Phone

(812) 824-5205

Fax

(812) 824-5207

NPI assigned

Jan 9, 2020

Last updated

Jan 9, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

Practice roles

Locations

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.

• Kroger Limited Partnership I

  dba Kroger Pharmacy

  • Community/Retail Pharmacy
  • Bloomington, IN
  • NPI 1013080324
  NPD
• Kroger Limited Partnership I

  dba Kroger Pharmacy #473

  • Community/Retail Pharmacy
  • Newport, KY
  • NPI 1104791078
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1578528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578528000000",
    "number": "1033759899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4025 S OLD STATE ROAD 37",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474017482",
            "telephone_number": "812-824-5205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4025 S OLD STATE ROAD 37",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474017482",
            "telephone_number": "812-824-5205",
            "fax_number": "812-824-5207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICK",
        "first_name": "JERRY",
        "middle_name": "WALTER",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-01-09",
        "last_updated": "2020-01-09",
        "certification_date": "2020-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "IN",
            "license": "26012786A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Scott Frasure, M.D.
• Kathy Annette Frasure, RN
• Jordan Mae Frazee, AUD
• Debora Frazier, ACSW, LCSW
• Laurette Susan Frazier, PHARMACIST, DSP.
• Cionna Freeman, RBT
• Jennifer L Freeman, M.A. CCC-SLP
• Joshua Freeman, LAT, ATC, CSCS
• Kimberly Jo Freeman, RPH
• Taylor French

• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.