Provider Demographics
NPI:1225351661
Name:FRESHWATER, HORACE Q JR
Entity Type:Individual
Prefix:
First Name:HORACE
Middle Name:Q
Last Name:FRESHWATER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 GLOBAL DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38141-8385
Mailing Address - Country:US
Mailing Address - Phone:901-547-3900
Mailing Address - Fax:
Practice Address - Street 1:1620 CENTURY CENTER PKWY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-0181
Practice Address - Country:US
Practice Address - Phone:901-547-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7134183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist