Provider Demographics
NPI:1942687116
Name:FREEDOM PHARMACY LLC
Entity Type:Organization
Organization Name:FREEDOM PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WICK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:855-539-7865
Mailing Address - Street 1:3605 EDGMONT AVE
Mailing Address - Street 2:BUILDING B
Mailing Address - City:BROOKHAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:19015-2807
Mailing Address - Country:US
Mailing Address - Phone:855-539-7865
Mailing Address - Fax:866-250-1718
Practice Address - Street 1:3605 EDGMONT AVE
Practice Address - Street 2:BUILDING B
Practice Address - City:BROOKHAVEN
Practice Address - State:PA
Practice Address - Zip Code:19015-2807
Practice Address - Country:US
Practice Address - Phone:855-539-7865
Practice Address - Fax:866-250-1718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-27
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4818273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy