Provider Demographics
NPI:1801971031
Name:FREEDOM PHARMACY INC
Entity type:Organization
Organization Name:FREEDOM PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-844-2924
Mailing Address - Street 1:3051 EL TUQUE INDUSTRIAL PARK
Mailing Address - Street 2:SUITES 102 AND 103
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-2201
Mailing Address - Country:US
Mailing Address - Phone:787-844-2924
Mailing Address - Fax:787-812-8113
Practice Address - Street 1:3051 EL TUQUE INDUSTRIAL PARK
Practice Address - Street 2:SUITES 102 AND 103
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-2201
Practice Address - Country:US
Practice Address - Phone:787-844-2924
Practice Address - Fax:787-812-8113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336M0002X
PR12F23393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4025436OtherNCPDP PROVIDER IDENTIFICATION NUMBER
4025436OtherNCPDP PROVIDER IDENTIFICATION NUMBER