=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033709993
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. DONALD EARL FREEMAN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2021
-----------------------------------------------------
Last Update Date | 01/24/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 360 THOMPSON ST
-----------------------------------------------------
City | CURWENSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16833-1158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-236-1820
-----------------------------------------------------
Fax | 814-236-9071
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 174
-----------------------------------------------------
City | HYDE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16843-0174
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-762-4239
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP040002L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------