Provider Demographics
NPI:1225434467
Name:LIBERTY BAY HEALTH SOLUTIONS LLC
Entity Type:Organization
Organization Name:LIBERTY BAY HEALTH SOLUTIONS LLC
Other - Org Name:MEDORGANIZE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOTT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:360-930-8197
Mailing Address - Street 1:PO BOX 2850
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-2850
Mailing Address - Country:US
Mailing Address - Phone:360-930-8197
Mailing Address - Fax:360-626-1913
Practice Address - Street 1:325 NE HOSTMARK ST STE B
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-6668
Practice Address - Country:US
Practice Address - Phone:360-930-8197
Practice Address - Fax:360-626-1913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-17
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
WAPHARCF605211673336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2148781OtherPK