MEDICARE: FREEDOM PHARMACY OF ARIZONA AT RED MOUNTAIN LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	Y006920	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2164187	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982152732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREEDOM PHARMACY OF ARIZONA AT RED MOUNTAIN LLC

Provider Business Mailing Address
First Line	:	8035 E BROWN RD
Second Line	:	BLDG 4, STE C
City	:	MESA
State	:	AZ
Zip	:	85207
Country	:	US
Telephone Number	:	480-565-7222
Fax Number	:	480-499-0396

Provider Business Practice Location Address
First Line	:	8035 E BROWN RD
Second Line	:	BLDG 4, STE C
City	:	MESA
State	:	AZ
Zip	:	85207-3901
Country	:	US
Telephone Number	:	480-565-7222
Fax Number	:	480-499-0396

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHRIS SHALER
Credential	:
Telephone Number	:	480-993-9646

Provider Enumeration Date	:	09/21/2016
Last Update Date	:	09/19/2025

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