Provider Demographics
NPI:1497350276
Name:FREEMAN, JILLIAN CRYSTAL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:CRYSTAL
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9807 WILLOW AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64134-2431
Mailing Address - Country:US
Mailing Address - Phone:816-223-0038
Mailing Address - Fax:
Practice Address - Street 1:8421 NW PRAIRIE VIEW RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64153-1842
Practice Address - Country:US
Practice Address - Phone:816-746-1933
Practice Address - Fax:816-741-8535
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020031376183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2020031376OtherPHARMACIST LICENSE