Provider Demographics
NPI:1558696146
Name:FREEMAN PHARMACY 2 INC
Entity Type:Organization
Organization Name:FREEMAN PHARMACY 2 INC
Other - Org Name:FREEMAN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-705-5555
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36803-0100
Mailing Address - Country:US
Mailing Address - Phone:334-705-5555
Mailing Address - Fax:334-705-5540
Practice Address - Street 1:3900 PEPPERELL PKWY STE 101
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-6026
Practice Address - Country:US
Practice Address - Phone:334-705-5555
Practice Address - Fax:334-705-5540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X
AL1132983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0136196OtherNCPDP PROVIDER IDENTIFICATION NUMBER
AL6385760001Medicare NSC