Provider Demographics
NPI:1225424070
Name:FREEDOMLINK RX PHARMACY LLC
Entity Type:Organization
Organization Name:FREEDOMLINK RX PHARMACY LLC
Other - Org Name:FREEDOMLINK RX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VP
Authorized Official - Prefix:
Authorized Official - First Name:HARLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-209-5132
Mailing Address - Street 1:4439 SUMMER MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18902-8803
Mailing Address - Country:US
Mailing Address - Phone:267-980-7272
Mailing Address - Fax:
Practice Address - Street 1:24340 SPERRY DR STE C
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1565
Practice Address - Country:US
Practice Address - Phone:440-249-5222
Practice Address - Fax:440-249-5223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-08
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OHRPT.022487050-03336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2151299OtherPK