Healthcare Provider Details

I. General information

NPI: 1124163753
Provider Name (Legal Business Name): FREEDOM APOTHECARY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N MAIN ST SUITE C
ONSTED MI
49265-9202
US

IV. Provider business mailing address

PO BOX 346
ONSTED MI
49265-0346
US

V. Phone/Fax

Practice location:
  • Phone: 517-467-7225
  • Fax: 517-467-4718
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5315012728
License Number StateMI

VIII. Authorized Official

Name: EINAR B TJOLSEN
Title or Position: OWNER PHARMACIST
Credential: PHARMD
Phone: 517-467-7225