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General NPI Number Information
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NPI Number | 1730170663
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Entity Type | Organization
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Legal Business Name | LIBERTY HOME PHARMACY CORPORATION
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Dates
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Enumeration Date | 10/31/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8881 LIBERTY LN
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-3477
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Country | US
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Telephone | 877-891-2545
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Fax | 877-891-2546
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Provider Business Mailing Address
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Address Line | PO BOX 20003
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City | FORT PIERCE
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State | FL
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Zip | 34979-0003
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Country | US
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Telephone | 877-891-2545
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Fax | 877-891-2546
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROBERT N MARK
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Credential |
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Telephone | 772-398-5800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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