Healthcare Provider Details

I. General information

NPI: 1134205479
Provider Name (Legal Business Name): LIBERTY PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2006
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 E SWAN ST
CENTERVILLE TN
37033-1446
US

IV. Provider business mailing address

PO BOX 258
CENTERVILLE TN
37033-0258
US

V. Phone/Fax

Practice location:
  • Phone: 931-729-2999
  • Fax: 931-729-3393
Mailing address:
  • Phone: 931-729-2999
  • Fax: 931-729-3393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2322
License Number StateTN

VIII. Authorized Official

Name: LINDA H MAYS
Title or Position: OWNER
Credential: PHARMD
Phone: 931-729-3541