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General NPI Number Information
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NPI Number | 1396047544
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Entity Type | Organization
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Legal Business Name | LIBERTY ROCK PHARMACY, INC.
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Dates
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Enumeration Date | 11/20/2010
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Last Update Date | 01/15/2014
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Provider Practice Location Address
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Address Line | 11806 101ST AVE
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City | SOUTH RICHMOND HILL
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State | NY
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Zip | 11419-1230
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Country | US
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Telephone | 718-880-2500
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Fax | 718-880-2501
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Provider Business Mailing Address
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Address Line | 11806 101ST AVE
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City | SOUTH RICHMOND HILL
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State | NY
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Zip | 11419-1230
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Country | US
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Telephone | 718-880-2500
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Fax | 718-880-2501
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Authorized Official
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Title or Position | SUPERVISING PHARMACIST
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Name | DR. APARNA RATHOD
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Credential | PHARMD, RPH
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Telephone | 718-880-2500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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