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General NPI Number Information
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NPI Number | 1629933692
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Entity Type | Organization
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Legal Business Name | LIBERTY COMPOUNDING LLC
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Dates
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Enumeration Date | 12/22/2025
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 1000 PARK CENTRE BLVD STE 136
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City | MIAMI
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State | FL
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Zip | 33169-5373
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Country | US
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Telephone | 602-705-6631
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 PARK CENTRE BLVD STE 136
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City | MIAMI
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State | FL
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Zip | 33169-5373
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | HEAD OF PHARMACY
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Name | MR. NICHOLAS VENTURA
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Credential |
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Telephone | 602-705-6631
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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