MEDICARE: PHILIP DEFREES 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	26015142A	IN

General Provider Information

NPI Number	:	1134723406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP DEFREES RPH

Provider Business Mailing Address
First Line	:	1700 N WALNUT ST
Second Line	:
City	:	HARTFORD CITY
State	:	IN
Zip	:	47348-1358
Country	:	US
Telephone Number	:	765-348-4134
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 N WALNUT ST
Second Line	:
City	:	HARTFORD CITY
State	:	IN
Zip	:	47348-1358
Country	:	US
Telephone Number	:	765-348-4134
Fax Number	:

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

Provider Enumeration Date	:	11/26/2020
Last Update Date	:	11/26/2020

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Directions to “ PHILIP DEFREES RPH” Practice Location

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