Organization · NPI-2

Liberty Medical, LLC

Pharmacy, Mail Order Pharmacy · Port Saint Lucie, FL

NPI number1649413832
StatusActive
Last updated in NPPESMar 7, 2023

Details

NPI
1649413832
Entity type
Organization (NPI-2)
Legal business name
Liberty Medical, LLC
Organization subpart
Yes
Enumeration date
Apr 17, 2009
Last updated
Mar 7, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
3336M0002X Pharmacy, Mail Order PharmacyPH28876FLYes

Practice location

8881 Liberty Ln
Port Saint Lucie, FL 34952-3477

Phone 800-491-3276 · Fax 877-592-8466

Mailing address

8881 Liberty Ln
Attn: Licensing
Port Saint Lucie, FL 34952-3477

Phone 772-398-5800 · Fax 844-363-4341

Authorized official

Jonathan Black
President
7723985800

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