Provider Demographics
NPI:1942739388
Name:LIBERTY PHARMACY, INC
Entity Type:Organization
Organization Name:LIBERTY PHARMACY, INC
Other - Org Name:LIBERTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARYANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-517-1627
Mailing Address - Street 1:7335 VAN NUYS BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-1951
Mailing Address - Country:US
Mailing Address - Phone:747-998-5610
Mailing Address - Fax:747-998-5611
Practice Address - Street 1:7335 VAN NUYS BLVD #107
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-1951
Practice Address - Country:US
Practice Address - Phone:747-998-5610
Practice Address - Fax:747-998-5611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA552753336C0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy