Provider Demographics
NPI:1134723406
Name:DEFREES, PHILIP (RPH)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:DEFREES
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 1:1700 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47348-1358
Mailing Address - Country:US
Mailing Address - Phone:765-348-4134
Mailing Address - Fax:
Practice Address - Street 1:1700 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:HARTFORD CITY
Practice Address - State:IN
Practice Address - Zip Code:47348-1358
Practice Address - Country:US
Practice Address - Phone:765-348-4134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-26
Last Update Date:2020-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26015142A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist