Provider Demographics
NPI:1699377432
Name:FREEMAN, BRITTON L
Entity Type:Individual
Prefix:
First Name:BRITTON
Middle Name:L
Last Name:FREEMAN
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 1:22469 HIGHWAY 42
Mailing Address - Street 2:
Mailing Address - City:RICHTON
Mailing Address - State:MS
Mailing Address - Zip Code:39476-2672
Mailing Address - Country:US
Mailing Address - Phone:601-270-2471
Mailing Address - Fax:
Practice Address - Street 1:WALMART PHARMACY
Practice Address - Street 2:1350 AZALEA DR
Practice Address - City:WAYNESBORO
Practice Address - State:MS
Practice Address - Zip Code:39367-0000
Practice Address - Country:US
Practice Address - Phone:601-735-3194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-7237183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty