Provider Demographics
NPI:1699195164
Name:LIBRTY FOR ALL PHARMACY
Entity Type:Organization
Organization Name:LIBRTY FOR ALL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TREPHENE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-245-8883
Mailing Address - Street 1:3034 S JOG RD
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2004
Mailing Address - Country:US
Mailing Address - Phone:754-245-8883
Mailing Address - Fax:954-533-1042
Practice Address - Street 1:3034 S JOG ROAD
Practice Address - Street 2:
Practice Address - City:LAKE WOTH
Practice Address - State:FL
Practice Address - Zip Code:33467-0000
Practice Address - Country:US
Practice Address - Phone:754-245-8883
Practice Address - Fax:954-533-1042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy