Melissa Fredericks, PHARMD
Individual provider Active NPI Pharmacist · Penitas, TX
NPI 1124628136 · NPPES record last updated Oct 28, 2020
Key facts
- NPI
- 1124628136
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 57112 (TX)
- Practice address
- 1705 Expressway 83
Penitas, TX 78576-8626 - Phone
- (956) 580-1511
- Fax
- (956) 580-1652
- NPI assigned
- Oct 28, 2020
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 57112 | TX | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 57112 | TX | Yes |
Addresses
Primary practice location
1705 Expressway 83
Penitas, TX 78576-8626
Mailing address
1705 Expressway 83
Penitas, TX 78576-8626
Phone (956) 580-1511
Other providers in Penitas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 28, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.