Healthcare Provider Details

I. General information

NPI: 1902728025
Provider Name (Legal Business Name): FREEDOM COMPOUNDING PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 STILLWATER RD
WILLERNIE MN
55090
US

IV. Provider business mailing address

PO BOX 298
WILLERNIE MN
55090-0298
US

V. Phone/Fax

Practice location:
  • Phone: 651-666-2117
  • Fax: 651-666-2113
Mailing address:
  • Phone: 651-666-2117
  • Fax: 651-666-2113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL FISCHER
Title or Position: OWNER
Credential: PHARMD
Phone: 651-666-2117