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General NPI Number Information
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NPI Number | 1598062150
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Entity Type | Organization
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Legal Business Name | LIBERTY PHARMACY
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Dates
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Enumeration Date | 02/17/2011
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Last Update Date | 02/18/2011
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Provider Practice Location Address
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Address Line | 3469 W BOYNTON BEACH BLVD
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City | BOYNTON BEACH
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State | FL
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Zip | 33436-4611
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Country | US
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Telephone | 561-649-3130
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Fax |
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Provider Business Mailing Address
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Address Line | 6176 BOXLEAF PL
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City | LAKE WORTH
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State | FL
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Zip | 33467-7114
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Country | US
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Telephone | 561-649-3130
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PRITIBEN DESAI
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Credential |
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Telephone | 561-649-3130
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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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