MEDICARE: MR. WORTHINGTON H FREEMAN RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	0202001278	VA

General Provider Information

NPI Number	:	1326339656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WORTHINGTON H FREEMAN RPH

Provider Business Mailing Address
First Line	:	551 HARBOR VIEW CIR
Second Line	:
City	:	OAK GROVE
State	:	VA
Zip	:	22443-5040
Country	:	US
Telephone Number	:	804-224-0261
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 MCKINNEY BLVD
Second Line	:
City	:	COLONIAL BEACH
State	:	VA
Zip	:	22443-1925
Country	:	US
Telephone Number	:	804-224-2318
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2011
Last Update Date	:	04/20/2011

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