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
—
—
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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