Provider Demographics
NPI:1699666511
Name:FREEMAN, JOVITA ROSE CABRAL
Entity type:Individual
Prefix:MRS
First Name:JOVITA ROSE
Middle Name:CABRAL
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JOVITA ROSE
Other - Middle Name:CABRAL
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:4100 BLUE DIAMOND RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-7717
Mailing Address - Country:US
Mailing Address - Phone:702-266-8050
Mailing Address - Fax:
Practice Address - Street 1:4100 BLUE DIAMOND RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-7717
Practice Address - Country:US
Practice Address - Phone:702-266-8050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV22586183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist