Provider Demographics
NPI:1679238919
Name:LIBERTY HEALTHCARE PHARMACY LLC
Entity Type:Organization
Organization Name:LIBERTY HEALTHCARE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FURQAN
Authorized Official - Middle Name:BASHIR
Authorized Official - Last Name:MUHAMMAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-220-3260
Mailing Address - Street 1:953 FRELINGHUYSEN AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07114-2103
Mailing Address - Country:US
Mailing Address - Phone:973-824-2627
Mailing Address - Fax:
Practice Address - Street 1:953 FRELINGHUYSEN AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07114-2103
Practice Address - Country:US
Practice Address - Phone:973-824-2627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy