Provider Demographics
NPI:1063826816
Name:FREEMANS COMPOUNDING PHARMACY INC
Entity Type:Organization
Organization Name:FREEMANS COMPOUNDING PHARMACY INC
Other - Org Name:FREEMAN'S COMPOUNDING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLSONCROFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-972-8328
Mailing Address - Street 1:4268 CAHABA HEIGHTS CT STE 121
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-5711
Mailing Address - Country:US
Mailing Address - Phone:205-972-8328
Mailing Address - Fax:205-972-8270
Practice Address - Street 1:4268 CAHABA HEIGHTS CT STE 121
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35243-5711
Practice Address - Country:US
Practice Address - Phone:205-972-8328
Practice Address - Fax:205-972-8270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-19
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1143683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2154858OtherPK