Provider Demographics
NPI:1407032410
Name:FREYTAG, DAVID PHILIP (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:PHILIP
Last Name:FREYTAG
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 1:625 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13365-1440
Mailing Address - Country:US
Mailing Address - Phone:315-823-0600
Mailing Address - Fax:315-823-4548
Practice Address - Street 1:625 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NY
Practice Address - Zip Code:13365-1440
Practice Address - Country:US
Practice Address - Phone:315-823-0600
Practice Address - Fax:315-823-4548
Is Sole Proprietor?:No
Enumeration Date:2008-01-21
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029494-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist