Provider Demographics
NPI:1972654242
Name:FREESE, RICHARD D (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:FREESE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8260 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-9388
Mailing Address - Country:US
Mailing Address - Phone:910-686-1182
Mailing Address - Fax:910-686-9224
Practice Address - Street 1:8260 MARKET ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-9388
Practice Address - Country:US
Practice Address - Phone:910-686-1182
Practice Address - Fax:910-686-9224
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23101183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02154227Medicaid
NY4174080001Medicare NSC