Healthcare Provider Details

I. General information

NPI: 1942817283
Provider Name (Legal Business Name): SARAH LIEBERGEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2020
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2329 JAMES ST
SYRACUSE NY
13206-3070
US

IV. Provider business mailing address

2329 JAMES ST
SYRACUSE NY
13206-3070
US

V. Phone/Fax

Practice location:
  • Phone: 315-437-0893
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number066119
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: