Active NPI
Kristian M. Fredriksen, PHARMD
- Pharmacist
- Vallejo, CA
National Provider Identifier
1295294551
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 79721
- Practice address
- 975 Sereno Dr
Vallejo, CA 94589-2441 - Phone
- (707) 651-1000
- NPI assigned
- Mar 17, 2019
- 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 | 79721 | CA | Primary |
Addresses
Primary practice location
975 Sereno Dr
Vallejo, CA 94589-2441
Mailing address
725 Valley Run
Hercules, CA 94547-1445
Phone (510) 253-6938
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 79721 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1552780800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1552780800000",
"number": "1295294551",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "725 VALLEY RUN",
"city": "HERCULES",
"state": "CA",
"postal_code": "945471445",
"telephone_number": "510-253-6938"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "975 SERENO DR",
"city": "VALLEJO",
"state": "CA",
"postal_code": "945892441",
"telephone_number": "707-651-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREDRIKSEN",
"first_name": "KRISTIAN",
"middle_name": "M.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-03-17",
"last_updated": "2019-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "79721",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vallejo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.