Provider Demographics
NPI:1346846136
Name:FREEMAN, ALLEN DALE II (RPH)
Entity Type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:DALE
Last Name:FREEMAN
Suffix:II
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 1:11400 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-5821
Mailing Address - Country:US
Mailing Address - Phone:804-360-9782
Mailing Address - Fax:
Practice Address - Street 1:11400 W BROAD ST RD
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-5821
Practice Address - Country:US
Practice Address - Phone:804-360-9782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202011045183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist