Provider Demographics
NPI:1093346546
Name:LIBERTY DRUG
Entity Type:Organization
Organization Name:LIBERTY DRUG
Other - Org Name:LIBERTY DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCHANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-810-0337
Mailing Address - Street 1:497 W 4800 S STE 100
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-4663
Mailing Address - Country:US
Mailing Address - Phone:801-810-0337
Mailing Address - Fax:877-540-2727
Practice Address - Street 1:497 W 4800 S STE 100
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123-4663
Practice Address - Country:US
Practice Address - Phone:801-810-0337
Practice Address - Fax:801-312-8760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-03
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy