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General NPI Number Information
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NPI Number | 1205915931
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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 | 11/03/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 905 N MAIN ST #4
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City | ADRIAN
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State | MI
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Zip | 49221-2168
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Country | US
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Telephone | 517-273-7300
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Fax | 517-263-7370
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Provider Business Mailing Address
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Address Line | 905 N MAIN ST #4
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City | ADRIAN
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State | MI
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Zip | 49221-2168
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Country | US
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Telephone | 517-273-7300
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Fax | 517-263-7370
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | DR. EINAR B TJOLSEN
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Credential | PHARM.D.
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Telephone | 517-263-7300
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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 | 5301006254
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License Number State | MI
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