Provider Demographics
NPI:1093283681
Name:LIBERTY DRUGS LLC
Entity Type:Organization
Organization Name:LIBERTY DRUGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KUNAL
Authorized Official - Middle Name:
Authorized Official - Last Name:NAGARSHETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-820-0101
Mailing Address - Street 1:2411 WILLIAMS DR STE 3
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-3261
Mailing Address - Country:US
Mailing Address - Phone:512-820-0101
Mailing Address - Fax:512-820-1244
Practice Address - Street 1:2411 WILLIAMS DR STE 3
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-3261
Practice Address - Country:US
Practice Address - Phone:512-820-0101
Practice Address - Fax:512-820-1244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1149753Medicaid