Healthcare Provider Details

I. General information

NPI: 1043735202
Provider Name (Legal Business Name): EMILY LIEBERMAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 08/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8184 WESTSIDE BLVD
FULTON MD
20759-2587
US

IV. Provider business mailing address

6408 MELLOW WINE WAY
COLUMBIA MD
21044-6029
US

V. Phone/Fax

Practice location:
  • Phone: 301-362-5765
  • Fax:
Mailing address:
  • Phone: 410-627-0401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20719
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: