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General NPI Number Information
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NPI Number | 1316251432
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Entity Type | Organization
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Legal Business Name | FREEDOM PHARMACY LLC
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Dates
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Enumeration Date | 07/30/2010
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Last Update Date | 07/10/2024
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Provider Practice Location Address
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Address Line | 710 4TH ST
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City | MENA
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State | AR
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Zip | 71953-3314
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Country | US
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Telephone | 479-437-3089
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Fax | 479-437-3842
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Provider Business Mailing Address
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Address Line | 710 4TH ST
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City | MENA
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State | AR
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Zip | 71953-3314
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Country | US
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Telephone | 479-437-3089
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Fax | 479-437-3842
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Authorized Official
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Title or Position | PHARMACIST / OWNER
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Name | BRIAN WALTER ERICKSON
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Credential | PHARM.D.
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Telephone | 479-437-3089
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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 | AR20630
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License Number State | AR
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