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General NPI Number Information
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NPI Number | 1851492078
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Entity Type | Organization
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Legal Business Name | LIBUN APOTHECARY & SURGICAL SUPPLY, INC
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 03/02/2016
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Provider Practice Location Address
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Address Line | 464 WASHINGTON ST
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City | QUINCY
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State | MA
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Zip | 02169-5716
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Country | US
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Telephone | 617-773-7733
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Fax | 617-773-8372
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Provider Business Mailing Address
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Address Line | 464 WASHINGTON ST
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City | QUINCY
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State | MA
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Zip | 02169-5716
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Country | US
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Telephone | 617-773-7733
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Fax | 617-773-8372
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. THOMAS R LIBBY
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Credential | RPH
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Telephone | 617-773-7733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 3502
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 3502
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License Number State | MA
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