Provider Demographics
NPI:1760951164
Name:OUR LIBERTY PHARMACY
Entity Type:Organization
Organization Name:OUR LIBERTY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOY
Authorized Official - Middle Name:C
Authorized Official - Last Name:NWANGWU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:443-657-7122
Mailing Address - Street 1:8511 LIBERTY RD STE CA
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-4840
Mailing Address - Country:US
Mailing Address - Phone:443-657-7122
Mailing Address - Fax:443-657-7375
Practice Address - Street 1:8511 LIBERTY RD STE CA
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-4840
Practice Address - Country:US
Practice Address - Phone:443-657-7122
Practice Address - Fax:443-657-7375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-15
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty