Provider Demographics
NPI:1821509845
Name:FREEDOM PHARMACY, LLC
Entity Type:Organization
Organization Name:FREEDOM PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:R.PH.
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:WIERCIOCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-722-8782
Mailing Address - Street 1:17330 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17330 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3158
Practice Address - Country:US
Practice Address - Phone:248-722-8782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5301011269OtherPHARMACY LICENSE