Healthcare Provider Details

I. General information

NPI: 1902961618
Provider Name (Legal Business Name): FREEMAN PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 W MLK HWY SUITE D
TUSKEGEE AL
36083-2104
US

IV. Provider business mailing address

209 W MLK HWY SUITE D
TUSKEGEE AL
36083-2104
US

V. Phone/Fax

Practice location:
  • Phone: 334-727-0047
  • Fax: 334-727-0886
Mailing address:
  • Phone: 334-727-0047
  • Fax: 334-727-0886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12782
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number12782
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number12782
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number12782
License Number StateAL

VIII. Authorized Official

Name: MR. MARKEL KYLE FREEMAN
Title or Position: OWNER
Credential: RPH
Phone: 334-727-0047