MEDICARE: LIBERTY RX PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1063125565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTY RX PHARMACY LLC

Provider Business Mailing Address
First Line	:	13000 MURPHY RD STE 102
Second Line	:
City	:	STAFFORD
State	:	TX
Zip	:	77477-3960
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13000 MURPHY RD STE 102
Second Line	:
City	:	STAFFORD
State	:	TX
Zip	:	77477-3960
Country	:	US
Telephone Number	:	346-527-4545
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TANISHA MORRIS
Credential	:
Telephone Number	:	346-527-4545

Provider Enumeration Date	:	12/29/2022
Last Update Date	:	02/03/2025

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Directions to “LIBERTY RX PHARMACY LLC ” Practice Location

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