Provider Demographics
NPI:1225311392
Name:LIEBERMAN, HARRY JAY (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:JAY
Last Name:LIEBERMAN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6025 LAKE WORTH RD
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-4288
Mailing Address - Country:US
Mailing Address - Phone:561-955-2180
Mailing Address - Fax:561-965-5951
Practice Address - Street 1:6025 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-4288
Practice Address - Country:US
Practice Address - Phone:561-955-2180
Practice Address - Fax:561-965-5951
Is Sole Proprietor?:No
Enumeration Date:2011-09-24
Last Update Date:2011-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37108183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS37108OtherFLORIDA STATE PHARMACIST LICENSE