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General NPI Number Information
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NPI Number | 1942687116
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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 | 04/27/2015
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Last Update Date | 01/25/2017
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Provider Practice Location Address
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Address Line | 3605 EDGMONT AVE BUILDING B
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City | BROOKHAVEN
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State | PA
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Zip | 19015-2807
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Country | US
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Telephone | 855-539-7865
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Fax | 866-250-1718
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Provider Business Mailing Address
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Address Line | 3605 EDGMONT AVE BUILDING B
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City | BROOKHAVEN
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State | PA
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Zip | 19015-2807
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Country | US
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Telephone | 855-539-7865
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Fax | 866-250-1718
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | MRS. KELLY A WICK
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Credential | RPH
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Telephone | 855-539-7865
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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 | PP481827
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License Number State | PA
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