# PHARMACY DIRECT DELIVERY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Freedom Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255753869
- **Authorized official:** MR. COREY JAMES DUTEAU R.PH. (MEMBER)
- **Authorized official phone:** (802) 655-3544

## Contact information

- **Practice address:** 434 HURRICANE LN STE 200, WILLISTON, VT 05495-2073
- **Practice address phone:** (802) 655-3544
- **Practice address fax:** (802) 655-0123
- **Mailing address:** 434 HURRICANE LN STE 200, WILLISTON, VT 05495-2073
- **Mailing address phone:** (802) 655-3544
- **Mailing address fax:** (802) 655-0123

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | 033054 | NY | — |
| 3336L0003X | Long Term Care Pharmacy | NR0990 | NH | — |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 01/16/2014
- **Last updated:** 09/16/2021

## 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 |