Provider Demographics
NPI:1619206737
Name:FREER PHARMACY LLC
Entity type:Organization
Organization Name:FREER PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:361-394-7733
Mailing Address - Street 1:PO BOX 1520
Mailing Address - Street 2:
Mailing Address - City:FREER
Mailing Address - State:TX
Mailing Address - Zip Code:78357-1520
Mailing Address - Country:US
Mailing Address - Phone:361-394-4433
Mailing Address - Fax:367-394-7744
Practice Address - Street 1:717 E. RILEY ST.
Practice Address - Street 2:SUITE C
Practice Address - City:FREER
Practice Address - State:TX
Practice Address - Zip Code:78357-1520
Practice Address - Country:US
Practice Address - Phone:361-394-7733
Practice Address - Fax:367-394-7744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-19
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
TX26728333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4554590OtherNCPDP PROVIDER IDENTIFICATION NUMBER