MEDICARE: DR. LAUREN M LIBMAN PHARM. D

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	071249	NY

General Provider Information

NPI Number	:	1265200240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAUREN M LIBMAN PHARM. D

Provider Business Mailing Address
First Line	:	104 W END AVE APT 6E
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-4956
Country	:	US
Telephone Number	:	917-861-1114
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 BRIGHTON BEACH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3369
Country	:	US
Telephone Number	:	718-769-5777
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2023
Last Update Date	:	12/19/2023

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