Basic Information
| Provider Information | |||||||||
| NPI: | 1851050793 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FREEMAN | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2695 PRICHARD RD | ||||||||
| Address2: | |||||||||
| City: | ONA | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045440896 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5000 KY ROUTE 321 | ||||||||
| Address2: | |||||||||
| City: | PRESTONSBURG | ||||||||
| State: | KY | ||||||||
| PostalCode: | 416539113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068868511 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2021 | ||||||||
| LastUpdateDate: | 12/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 021556 | KY | N | Pharmacy Service Providers | Pharmacist | 183500000X | RP0011693 | WV | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.