Healthcare Provider Details

I. General information

NPI: 1053899419
Provider Name (Legal Business Name): CASSAUNDRA S FREEMAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASSAUNDRA S GROOMS PHARMD

II. Dates (important events)

Enumeration Date: 07/29/2018
Last Update Date: 07/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

962 S DORSET RD
TROY OH
45373-4705
US

IV. Provider business mailing address

920 ALEXANDERSVILLE RD
MIAMISBURG OH
45342-3988
US

V. Phone/Fax

Practice location:
  • Phone: 855-772-2725
  • Fax:
Mailing address:
  • Phone: 513-509-0314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202216254
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03236832
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: