Provider Demographics
NPI:1043592322
Name:FREETHY, DENISE (RPH)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:FREETHY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 E RIVERSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-4850
Mailing Address - Country:US
Mailing Address - Phone:815-633-0475
Mailing Address - Fax:815-633-0853
Practice Address - Street 1:1704 E RIVERSIDE BLVD
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-4850
Practice Address - Country:US
Practice Address - Phone:815-633-0475
Practice Address - Fax:815-633-0853
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051035242183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist