Provider Demographics
NPI:1760457949
Name:FREEDOM PHARMACY INC
Entity Type:Organization
Organization Name:FREEDOM PHARMACY INC
Other - Org Name:FREEDOM PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:JAGRUT
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-824-2627
Mailing Address - Street 1:953 FRELINGHUYSEN AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07114-2103
Mailing Address - Country:US
Mailing Address - Phone:973-824-2627
Mailing Address - Fax:973-824-2629
Practice Address - Street 1:953 FRELINGHUYSEN AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07114-2103
Practice Address - Country:US
Practice Address - Phone:973-824-2627
Practice Address - Fax:973-824-2629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJRS006767003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2055773OtherPK