Provider Demographics
NPI:1396397451
Name:FREEMAN, JAMES RICKY III (PHARM D)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:RICKY
Last Name:FREEMAN
Suffix:III
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 1:1570 W MAGGIO WAY APT B2060
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-8180
Mailing Address - Country:US
Mailing Address - Phone:602-919-8228
Mailing Address - Fax:
Practice Address - Street 1:1142 W GUADALUPE RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-7602
Practice Address - Country:US
Practice Address - Phone:480-345-7367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS023983183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist