Provider Demographics
NPI:1578321048
Name:FREITAG, JOSHUA LEE PRINCE
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:LEE PRINCE
Last Name:FREITAG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HENSONSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-9350
Mailing Address - Country:US
Mailing Address - Phone:507-230-0830
Mailing Address - Fax:
Practice Address - Street 1:301 PARK DR
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-5639
Practice Address - Country:US
Practice Address - Phone:507-451-1771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN125908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist