Healthcare Provider Details

I. General information

NPI: 1093346546
Provider Name (Legal Business Name): LIBERTY DRUG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

497 W 4800 S STE 100
MURRAY UT
84123-4663
US

IV. Provider business mailing address

497 W 4800 S STE 100
MURRAY UT
84123-4663
US

V. Phone/Fax

Practice location:
  • Phone: 801-810-0337
  • Fax: 801-312-8760
Mailing address:
  • Phone: 801-810-0337
  • Fax: 877-540-2727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MS. JENNIFER MERCHANT
Title or Position: OWNER
Credential:
Phone: 801-810-0337