Provider Demographics
NPI:1558490235
Name:FREITAS, MARK PATRICK (RPH)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:PATRICK
Last Name:FREITAS
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 1:32 W MAIN ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:WASHINGTONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10992-1411
Mailing Address - Country:US
Mailing Address - Phone:845-496-8001
Mailing Address - Fax:845-496-8005
Practice Address - Street 1:32 W MAIN ST UNIT 2
Practice Address - Street 2:
Practice Address - City:WASHINGTONVILLE
Practice Address - State:NY
Practice Address - Zip Code:10992-1411
Practice Address - Country:US
Practice Address - Phone:845-496-8001
Practice Address - Fax:845-496-8005
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJR26118183500000X
PARP041340R183500000X
NY039972183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist