Provider Demographics
NPI:1558703983
Name:FREESE, REBECCA ANNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANNE
Last Name:FREESE
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 1:15880 SAN CARLOS BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-3383
Mailing Address - Country:US
Mailing Address - Phone:772-631-8173
Mailing Address - Fax:
Practice Address - Street 1:15880 SAN CARLOS BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3383
Practice Address - Country:US
Practice Address - Phone:772-631-8173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS50731183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist