Provider Demographics
NPI:1013793264
Name:FREEDOM PHARMACY LLC
Entity Type:Organization
Organization Name:FREEDOM PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:337-287-9599
Mailing Address - Street 1:3901 MAPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-6351
Mailing Address - Country:US
Mailing Address - Phone:337-287-9599
Mailing Address - Fax:337-287-9566
Practice Address - Street 1:3901 MAPLEWOOD DR
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-6351
Practice Address - Country:US
Practice Address - Phone:337-287-9599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-05
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy