Active NPI
Mariovani P De Freitas, PHARM.D
- Pharmacist
- Goshen, IN
National Provider Identifier
1689956450
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 26020759A
- Practice address
- 1755 Lincolnway E
Goshen, IN 46526-6425 - Phone
- (574) 533-4932
- NPI assigned
- Sep 16, 2011
- Last updated
- Dec 2, 2022
- Sex
- Male
- Sole proprietor
- No
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 | 26020759A | IN | Primary |
Addresses
Primary practice location
1755 Lincolnway E
Goshen, IN 46526-6425
Mailing address
67100 County Road 1
Wakarusa, IN 46573-9516
Phone (574) 862-1628
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26020759A | IN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Pharmacy
- Goshen, IN
- NPI 1124205117
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1316131200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1669939200000",
"number": "1689956450",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "67100 COUNTY ROAD 1",
"city": "WAKARUSA",
"state": "IN",
"postal_code": "465739516",
"telephone_number": "574-862-1628"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1755 LINCOLNWAY E",
"city": "GOSHEN",
"state": "IN",
"postal_code": "465266425",
"telephone_number": "574-533-4932"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DE FREITAS",
"first_name": "MARIOVANI",
"middle_name": "P",
"name_prefix": "Dr.",
"credential": "PHARM.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-09-16",
"last_updated": "2022-12-02",
"certification_date": "2022-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IN",
"license": "26020759A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Goshen, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.