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Organization
PHARMACY DIRECT DELIVERY LLC
Active
Organization
PHARMACY DIRECT DELIVERY LLC
Active
Other names
Freedom Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. COREY JAMES DUTEAU R.PH. (MEMBER)
(802) 655-3544
Entity
Organization
Contact information
Practice address
434 HURRICANE LN STE 200, WILLISTON, VT 05495-2073
(802) 655-3544
(802) 655-0123
Mailing address
434 HURRICANE LN STE 200, WILLISTON, VT 05495-2073
(802) 655-3544
(802) 655-0123
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
033054
NY
3336L0003X
Long Term Care Pharmacy
NR0990
NH
3336L0003X
Long Term Care Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
033054
STATE LICENSE
NY
01
—
038.0134046
STATE LICENSE
VT
05
—
06454686
—
NY
05
—
1022646
—
VT
01
—
2143851
PK
—
05
—
3095901
—
NH
01
—
NR0990
STATE LICENSE
NH
Enumeration date
01/16/2014
Last updated
09/16/2021
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