MEDICARE: LIBERTY PHARMACY, INC

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	2322	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4427161	OTHER	TN	NCPDP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134205479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTY PHARMACY, INC

Provider Business Mailing Address
First Line	:	PO BOX 258
Second Line	:
City	:	CENTERVILLE
State	:	TN
Zip	:	37033-0258
Country	:	US
Telephone Number	:	931-729-2999
Fax Number	:	931-729-3393

Provider Business Practice Location Address
First Line	:	146 E SWAN ST
Second Line	:
City	:	CENTERVILLE
State	:	TN
Zip	:	37033-1446
Country	:	US
Telephone Number	:	931-729-2999
Fax Number	:	931-729-3393

Authorized Official
Title or Position	:	OWNER
Name	:	LINDA H MAYS
Credential	:	PHARMD
Telephone Number	:	931-729-3541

Provider Enumeration Date	:	10/30/2006
Last Update Date	:	04/10/2025

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Directions to “LIBERTY PHARMACY, INC ” Practice Location

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