Provider Demographics
NPI:1235730011
Name:FRIEDMAN, JEFFREY CARL (RPH)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:CARL
Last Name:FRIEDMAN
Suffix:
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 1:2373 S FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-3017
Mailing Address - Country:US
Mailing Address - Phone:417-631-1133
Mailing Address - Fax:
Practice Address - Street 1:3315 S CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-4914
Practice Address - Country:US
Practice Address - Phone:417-887-0855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20100385193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy