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General NPI Number Information
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NPI Number | 1003905589
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Entity Type | Organization
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Legal Business Name | FREEDOM APOTHECARY INC
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 75 E BENNETT ST
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City | SALINE
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State | MI
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Zip | 48176-1204
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Country | US
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Telephone | 734-429-0509
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 663 75 E BENNETT
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City | SALINE
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State | MI
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Zip | 48176-0663
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Country | US
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Telephone | 734-429-0509
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Fax |
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | MS. MARTHA L TJOLSEN
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Credential | RPH
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Telephone | 734-429-0509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301007376
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License Number State | MI
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