MEDICARE: LIBERTY PHARMACY

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	:	1598062150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTY PHARMACY

Provider Business Mailing Address
First Line	:	6176 BOXLEAF PL
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-7114
Country	:	US
Telephone Number	:	561-649-3130
Fax Number	:

Provider Business Practice Location Address
First Line	:	3469 W BOYNTON BEACH BLVD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-4611
Country	:	US
Telephone Number	:	561-649-3130
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PRITIBEN DESAI
Credential	:
Telephone Number	:	561-649-3130

Provider Enumeration Date	:	02/17/2011
Last Update Date	:	02/18/2011

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Directions to “LIBERTY PHARMACY ” Practice Location

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