Provider Demographics
NPI:1912595612
Name:FREEMAN, KERRY SARA (RPH)
Entity Type:Individual
Prefix:MS
First Name:KERRY
Middle Name:SARA
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2036 WHISTLING SWAN CIR
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-8234
Mailing Address - Country:US
Mailing Address - Phone:920-562-3748
Mailing Address - Fax:
Practice Address - Street 1:700 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-3511
Practice Address - Country:US
Practice Address - Phone:920-991-1190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13128-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist