Provider Demographics
NPI:1598328981
Name:FREELAND, DEBORAH GAVLAK
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:GAVLAK
Last Name:FREELAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21920 ROUTE 119
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-7975
Mailing Address - Country:US
Mailing Address - Phone:814-938-8100
Mailing Address - Fax:
Practice Address - Street 1:21920 ROUTE 119
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-7975
Practice Address - Country:US
Practice Address - Phone:814-938-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-21
Last Update Date:2019-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP043493L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP043493LOtherSTATE LICENSE