MEDICARE: SARAH LIEBERGEN PHARMD

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	183500000X	Pharmacist	066119	NY

General Provider Information

NPI Number	:	1942817283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH LIEBERGEN PHARMD

Provider Business Mailing Address
First Line	:	2329 JAMES ST
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13206-3070
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2329 JAMES ST
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13206-3070
Country	:	US
Telephone Number	:	315-437-0893
Fax Number	:

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

Provider Enumeration Date	:	09/30/2020
Last Update Date	:	09/30/2020

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