Organization
JAI GURU MAHARAJ INC
Active
Other names
FREEDOM PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
PHILIP BURDSAL (PRESIDENT)
(813) 368-3277
Entity
Organization
Contact information
Practice address
10700 JOHNSON BLVD, STE 1, SEMINOLE, FL 33772-4821
(727) 397-5020
(727) 397-9381
Mailing address
10700 JOHNSON BLVD, STE 1, SEMINOLE, FL 33772-4821
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
PH22533
FL
3336H0001X
Home Infusion Therapy Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1027956
OTHER ID NUMBER
—
Enumeration date
08/06/2007
Last updated
09/13/2007
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