Provider Demographics
NPI:1760547301
Name:FREEMAN PHARMACY, INC.
Entity Type:Organization
Organization Name:FREEMAN PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-727-0047
Mailing Address - Street 1:209 W. MLK HWY.
Mailing Address - Street 2:SUITE D
Mailing Address - City:TUSKEGEE
Mailing Address - State:AL
Mailing Address - Zip Code:36083
Mailing Address - Country:US
Mailing Address - Phone:334-727-0047
Mailing Address - Fax:334-727-0886
Practice Address - Street 1:209 W MLK HWY
Practice Address - Street 2:SUITE D
Practice Address - City:TUSKEGEE
Practice Address - State:AL
Practice Address - Zip Code:36083
Practice Address - Country:US
Practice Address - Phone:334-727-0047
Practice Address - Fax:334-727-0886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12782183500000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
510G730009OtherMASS IMMUNIZATION PTAN
AL009910826Medicaid