Healthcare Provider Details

I. General information

NPI: 1982975637
Provider Name (Legal Business Name): FREEMAN PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E SPRING AVE
CONWAY SPRINGS KS
67031-3101
US

IV. Provider business mailing address

PO BOX 5
CONWAY SPRINGS KS
67031-0005
US

V. Phone/Fax

Practice location:
  • Phone: 620-456-2220
  • Fax: 620-456-2231
Mailing address:
  • Phone: 620-456-2220
  • Fax: 620-456-2231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2-10386
License Number StateKS

VIII. Authorized Official

Name: LANCE FREEMAN
Title or Position: OFFICER
Credential:
Phone: 620-456-2220