Provider Demographics
NPI:1770872525
Name:FREESE, RICHARD A (RPH)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:A
Last Name:FREESE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:681 BROOKLEDGE CT
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44067-3086
Mailing Address - Country:US
Mailing Address - Phone:216-536-3923
Mailing Address - Fax:
Practice Address - Street 1:34099 MELINZ PKWY
Practice Address - Street 2:G
Practice Address - City:EASTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44095-4041
Practice Address - Country:US
Practice Address - Phone:440-953-0604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03325651183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03325651OtherOHIO PHARMACIST LICENSE