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General NPI Number Information
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NPI Number | 1457862088
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Entity Type | Organization
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Legal Business Name | THE LIBERTY PHARMACY
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Dates
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Enumeration Date | 10/23/2017
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Last Update Date | 10/23/2017
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Provider Practice Location Address
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Address Line | 4875 HIGBEE AVE NW
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City | CANTON
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State | OH
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Zip | 44718-2566
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Country | US
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Telephone | 330-936-2068
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Fax |
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Provider Business Mailing Address
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Address Line | 4875 HIGBEE AVE NW
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City | CANTON
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State | OH
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Zip | 44718-2566
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Country | US
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Telephone | 330-936-2068
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SHELLY KAY RENTSCH
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Credential |
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Telephone | 330-936-2068
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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 | 02276400
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License Number State | OH
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