Provider Demographics
NPI:1639461452
Name:FREEMAN, LANCE MICHAEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:MICHAEL
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:KS
Mailing Address - Zip Code:67003-2728
Mailing Address - Country:US
Mailing Address - Phone:620-842-5119
Mailing Address - Fax:620-842-3184
Practice Address - Street 1:202 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:KS
Practice Address - Zip Code:67003-2728
Practice Address - Country:US
Practice Address - Phone:620-842-5119
Practice Address - Fax:620-842-3184
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-15217183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist