Provider Demographics
NPI:1689914624
Name:FREEMAN, JAKE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JAKE
Middle Name:
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 1:19 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-2744
Mailing Address - Country:US
Mailing Address - Phone:516-799-3801
Mailing Address - Fax:
Practice Address - Street 1:19 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-2744
Practice Address - Country:US
Practice Address - Phone:516-799-3801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056979183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist