MEDICARE: LIBERTY PHARMACY INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	031201	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	031201	OTHER	NY	NYS PHARMACY LICENSE

General Provider Information

NPI Number	:	1093075236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTY PHARMACY INC.

Provider Business Mailing Address
First Line	:	12402A LIBERTY AVE
Second Line	:
City	:	SOUTH RICHMOND HILL
State	:	NY
Zip	:	11419-2232
Country	:	US
Telephone Number	:	718-738-1500
Fax Number	:

Provider Business Practice Location Address
First Line	:	12402A LIBERTY AVE
Second Line	:
City	:	SOUTH RICHMOND HILL
State	:	NY
Zip	:	11419-2232
Country	:	US
Telephone Number	:	718-738-1500
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	AYESHA FURQUAN
Credential	:
Telephone Number	:	718-738-1500

Provider Enumeration Date	:	05/22/2012
Last Update Date	:	07/09/2012

Similar Medicare Providers

1922055235 — SEIDENBERG PROTZKO SURGERY CENTER LLC
Practice Location Address:

1111 BEARDS HILL RD , SUITE 700
ABERDEEN, MD
21001-2232

Practice Phone: 410-273-9096
Practice Fax: 410-273-9146

1134231103 — SUSAN MELTON SCHMIEG P.T.
Practice Location Address:

3000 HERITAGE FARM CT
OAK HILL, VA
20171-2232

Practice Phone: 703-476-1982
Practice Fax:

1750594347 — SECURUS ANESTHESIA LLC
Practice Location Address:

1111 BEARDS HILL RD , SUITE 700
ABERDEEN, MD
21001-2232

Practice Phone: 410-273-9096
Practice Fax:

1609004654 — BEVERLY JEAN HEIMBACH OTR/L
Practice Location Address:

2206 OAKWYN RD
LAFAYETTE HILL, PA
19444-2232

Practice Phone: 610-239-7100
Practice Fax:

1407498207 — ASAP TRANS INC
Practice Location Address:

718 RATCLIFFE AVE
RICHMOND, VA
23222-2232

Practice Phone: 804-477-5956
Practice Fax:

1699308684 — SHERRI JO SHORT
Practice Location Address:

106 LONGVIEW DR
RICHMOND, KY
40475-2232

Practice Phone: 859-200-5882
Practice Fax:

Directions to “LIBERTY PHARMACY INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.