MEDICARE: FREEDOM RX LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1013672922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREEDOM RX LLC

Provider Business Mailing Address
First Line	:	1242 E BUSINESS HIGHWAY 83 STE 7
Second Line	:
City	:	MISSION
State	:	TX
Zip	:	78572-9308
Country	:	US
Telephone Number	:	956-583-2700
Fax Number	:	956-683-6152

Provider Business Practice Location Address
First Line	:	202 W RICE ST
Second Line	:
City	:	FALFURRIAS
State	:	TX
Zip	:	78355-3704
Country	:	US
Telephone Number	:	361-325-2662
Fax Number	:	361-325-5177

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOSE G VARGAS
Credential	:
Telephone Number	:	956-534-6990

Provider Enumeration Date	:	11/04/2021
Last Update Date	:	11/04/2021

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Directions to “FREEDOM RX LLC ” Practice Location

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