Organization
FREEDOM APOTHECARY III INC
Active
Other names
NEW BOSTON PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MARTHA TJOLSEN RPH (VP AND PHARM)
(735) 753-9480
Entity
Organization
Contact information
Practice address
19162 HURON RIVER DR, NEW BOSTON, MI 48164-9727
(734) 753-9480
(734) 753-5397
Mailing address
PO BOX 691, NEW BOSTON, MI 48164-0691
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
5301008319
MI
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2368062
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/30/2006
Last updated
04/09/2008
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