Provider Demographics
NPI:1255708848
Name:LIBERTY TOWNSHIP
Entity type:Organization
Organization Name:LIBERTY TOWNSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NANETTE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-701-5503
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:OH
Mailing Address - Zip Code:45647-0151
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:34568 US HIGHWAY 50
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:OH
Practice Address - Zip Code:45647-9772
Practice Address - Country:US
Practice Address - Phone:740-887-4515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-31
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
020719700OtherBOARD OF PHARMACY