Active NPI
Susan C Freese, RPH
- Pharmacist
- Ilwaco, WA
National Provider Identifier
1285771774
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH00010369
- Practice address
- 101 1St Ave S
Ilwaco, WA 98624-0167 - Phone
- (360) 642-3133
- Fax
- (360) 642-5133
- NPI assigned
- Jan 31, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PH00010369 | WA | Primary |
Addresses
Primary practice location
101 1St Ave S
Ilwaco, WA 98624-0167
Mailing address
PO Box 189
Long Beach, WA 98631-0189
Phone (360) 642-3133
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PH00010369 | Other | WA | PHARMACIST |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PH00010369 | WA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1285771774",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 189",
"city": "LONG BEACH",
"state": "WA",
"postal_code": "986310189",
"telephone_number": "360-642-3133",
"fax_number": "360-642-5133"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 1ST AVE S",
"city": "ILWACO",
"state": "WA",
"postal_code": "986240167",
"telephone_number": "360-642-3133",
"fax_number": "360-642-5133"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREESE",
"first_name": "SUSAN",
"middle_name": "C",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH00010369",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACIST",
"identifier": "PH00010369",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ilwaco, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.