Provider Demographics
NPI:1376110007
Name:FREIBERG, JASON (PHARM D)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:FREIBERG
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2039 CROSSROADS BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-1215
Mailing Address - Country:US
Mailing Address - Phone:319-888-1724
Mailing Address - Fax:
Practice Address - Street 1:2039 CROSSROADS BLVD STE B
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-1215
Practice Address - Country:US
Practice Address - Phone:319-888-1724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19972183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist