Provider Demographics
NPI:1619740701
Name:LIBERTY RX INC.
Entity Type:Organization
Organization Name:LIBERTY RX INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:FARHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-880-2053
Mailing Address - Street 1:12704 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11419-2216
Mailing Address - Country:US
Mailing Address - Phone:718-880-2053
Mailing Address - Fax:718-880-2081
Practice Address - Street 1:12704 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11419-2216
Practice Address - Country:US
Practice Address - Phone:718-880-2053
Practice Address - Fax:718-880-2081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy