Provider Demographics
NPI:1871882423
Name:FREEMAN, RICHARD GIBSON (RPH)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:GIBSON
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3241
Mailing Address - Country:US
Mailing Address - Phone:770-838-1860
Mailing Address - Fax:
Practice Address - Street 1:125 S PARK ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3241
Practice Address - Country:US
Practice Address - Phone:770-838-1860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11305183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist