Healthcare Provider Details

I. General information

NPI: 1265169262
Provider Name (Legal Business Name): LIBERTY RX PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2022
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2458 ERRINGER RD
SIMI VALLEY CA
93065-2351
US

IV. Provider business mailing address

2458 ERRINGER RD
SIMI VALLEY CA
93065-2351
US

V. Phone/Fax

Practice location:
  • Phone: 805-977-6337
  • Fax:
Mailing address:
  • Phone: 805-977-6337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SARKIS BLUDYAN
Title or Position: CFO
Credential:
Phone: 424-777-8990