MEDICARE: JOHN ROBINSON FREEMAN

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	03331131	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	03331131	OTHER	OH	PHARMACY LICENSE

General Provider Information

NPI Number	:	1285143255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN ROBINSON FREEMAN

Provider Business Mailing Address
First Line	:	4047 HARRISON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-4639
Country	:	US
Telephone Number	:	513-470-9732
Fax Number	:

Provider Business Practice Location Address
First Line	:	2212 SPINNINGWHEEL LN
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45244-4115
Country	:	US
Telephone Number	:	513-624-6412
Fax Number	:

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

Provider Enumeration Date	:	09/22/2017
Last Update Date	:	09/22/2017

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