Provider Demographics
NPI:1841741634
Name:LIEBMAN, ZACHARY E (PHARMD)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:E
Last Name:LIEBMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1054 LAW ST
Mailing Address - Street 2:APT A
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-2667
Mailing Address - Country:US
Mailing Address - Phone:716-535-0488
Mailing Address - Fax:
Practice Address - Street 1:1792 GARNET AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-3350
Practice Address - Country:US
Practice Address - Phone:858-483-1489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71886183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist