MEDICARE: DR. DANYELLE LEATRICE 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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	PS58671	FL

General Provider Information

NPI Number	:	1699386201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANYELLE LEATRICE FREEMAN RPH

Provider Business Mailing Address
First Line	:	7110 OKEECHOBEE BLVD APT 6403
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-2464
Country	:	US
Telephone Number	:	850-322-0992
Fax Number	:

Provider Business Practice Location Address
First Line	:	3401 PGA BLVD STE 110
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33410-2824
Country	:	US
Telephone Number	:	561-493-8840
Fax Number	:	561-493-8846

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

Provider Enumeration Date	:	08/17/2020
Last Update Date	:	08/17/2020

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