Forever Young Pharmacy

Primary specialty

Mail Order PharmacyTaxonomy code 3336M0002X

Legal business name

FOREVER YOUNG PHARMACY

Practice address

6351 Corte del Abeto Ste 111
Carlsbad, CA 92011-1429

Phone

(714) 757-7584

NPI assigned

May 3, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Dane David Fredericksen, PHARM. D.

Title

Owner

Phone

(714) 757-7584

Specialties & licenses 3

Addresses

Other names 2

• Forever Young Pharmacy Doing business as
• Forever Young Rx Doing business as

Locations

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

{
    "created_epoch": "1683072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683072000000",
    "number": "1184313355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6351 CORTE DEL ABETO STE 111",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920111429",
            "telephone_number": "714-757-7584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6351 CORTE DEL ABETO STE 111",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920111429",
            "telephone_number": "714-757-7584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOREVER YOUNG PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-03",
        "last_updated": "2023-05-03",
        "certification_date": "2023-05-03",
        "status": "A",
        "authorized_official_last_name": "FREDERICKSEN",
        "authorized_official_first_name": "DANE",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "714-757-7584",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARM. D."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336M0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Mail Order Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Forever Young Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Forever Young Rx",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nashieeli Fondren
• Kim Fong
• Angeline Fonseca
• Denise Ford, PHYSICIAN ASSISTANT
• Emily Forester
• Jillian Marie Foronda
• Madison Taylor Forst
• Terry L Forward, D.C./QME
• Tatiana Juliette Fossey
• Christopher Minh Fountain, MSN, FNP-C

• Mail Order Pharmacy in Carlsbad, CA
• Providers in Carlsbad, CA by specialty
• Mail Order Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2023; 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.