Provider Demographics
NPI:1003172271
Name:FREITAS, GERALD LEE I (RPH)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:LEE
Last Name:FREITAS
Suffix:I
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8364 ROVANA CIR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95828-2522
Mailing Address - Country:US
Mailing Address - Phone:916-379-1657
Mailing Address - Fax:916-379-1691
Practice Address - Street 1:8364 ROVANA CIR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95828-2522
Practice Address - Country:US
Practice Address - Phone:916-379-1657
Practice Address - Fax:916-379-1691
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28001183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist