Healthcare Provider Details

I. General information

NPI: 1013793264
Provider Name (Legal Business Name): FREEDOM PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2023
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 MAPLEWOOD DR
SULPHUR LA
70663-6351
US

IV. Provider business mailing address

3901 MAPLEWOOD DR
SULPHUR LA
70663-6351
US

V. Phone/Fax

Practice location:
  • Phone: 337-287-9599
  • Fax:
Mailing address:
  • Phone: 337-287-9599
  • Fax: 337-287-9566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. LARRY DALE COLLINS JR.
Title or Position: PIC/OWNER
Credential: PHARMD
Phone: 337-287-9599