Provider Demographics
NPI:1871879148
Name:FREED, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:FREED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CHRISTINA WOODS CT
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-2724
Mailing Address - Country:US
Mailing Address - Phone:302-454-9090
Mailing Address - Fax:
Practice Address - Street 1:287 CHRISTIANA RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-2978
Practice Address - Country:US
Practice Address - Phone:302-325-1098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0003075183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist