Provider Demographics
NPI:1457862088
Name:THE LIBERTY PHARMACY
Entity Type:Organization
Organization Name:THE LIBERTY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:RENTSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-936-2068
Mailing Address - Street 1:4875 HIGBEE AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2566
Mailing Address - Country:US
Mailing Address - Phone:330-936-2068
Mailing Address - Fax:
Practice Address - Street 1:4875 HIGBEE AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2566
Practice Address - Country:US
Practice Address - Phone:330-936-2068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NASHAT Y GABRAIL MD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH022764003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy