Healthcare Provider Details

I. General information

NPI: 1699377432
Provider Name (Legal Business Name): BRITTON L FREEMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 11/16/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WALMART PHARMACY 1350 AZALEA DR
WAYNESBORO MS
39367-0000
US

IV. Provider business mailing address

22469 HIGHWAY 42
RICHTON MS
39476-2672
US

V. Phone/Fax

Practice location:
  • Phone: 601-735-3194
  • Fax:
Mailing address:
  • Phone: 601-270-2471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-7237
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: