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General NPI Number Information
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NPI Number | 1942739388
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Entity Type | Organization
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Legal Business Name | LIBERTY PHARMACY, INC
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Dates
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Enumeration Date | 06/08/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 7335 VAN NUYS BLVD #107
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City | VAN NUYS
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State | CA
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Zip | 91405-1951
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Country | US
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Telephone | 747-998-5610
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Fax | 747-998-5611
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Provider Business Mailing Address
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Address Line | 7335 VAN NUYS BLVD STE 107
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City | VAN NUYS
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State | CA
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Zip | 91405-1951
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Country | US
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Telephone | 747-998-5610
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Fax | 747-998-5611
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Authorized Official
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Title or Position | PHARMACY ADMINISTRATOR
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Name | MARYANNA ANDERSON
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Credential |
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Telephone | 818-517-1627
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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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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 55275
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License Number State | CA
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