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	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1457166472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREEDOM RX LLC

Provider Business Mailing 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

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	:	VICE-PRESIDENT
Name	:	JOSE G VARGAS
Credential	:
Telephone Number	:	956-534-6990

Provider Enumeration Date	:	02/07/2025
Last Update Date	:	02/07/2025

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Directions to “FREEDOM RX LLC ” Practice Location

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