Provider Demographics
NPI:1912594250
Name:FREEMAN, DANIEL SCOTT
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:SCOTT
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 1:425 MAIN ST W
Mailing Address - Street 2:
Mailing Address - City:CANNON FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:55009-2044
Mailing Address - Country:US
Mailing Address - Phone:507-263-2881
Mailing Address - Fax:844-217-4343
Practice Address - Street 1:425 MAIN ST W
Practice Address - Street 2:
Practice Address - City:CANNON FALLS
Practice Address - State:MN
Practice Address - Zip Code:55009-2044
Practice Address - Country:US
Practice Address - Phone:507-263-2881
Practice Address - Fax:844-217-4343
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115221183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist