Provider Demographics
NPI:1598495772
Name:EMBACHER, LIBERTY (PHARMD)
Entity Type:Individual
Prefix:
First Name:LIBERTY
Middle Name:
Last Name:EMBACHER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 THREE SPRINGS DR STE 3
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-3815
Mailing Address - Country:US
Mailing Address - Phone:304-207-9856
Mailing Address - Fax:
Practice Address - Street 1:204 THREE SPRINGS DR STE 3
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-3815
Practice Address - Country:US
Practice Address - Phone:304-207-9856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-12
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03441495183500000X
WVRP0012748183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist