Provider Demographics
NPI:1720301872
Name:LIBERMAN, EDGAR HOWARD
Entity Type:Individual
Prefix:
First Name:EDGAR
Middle Name:HOWARD
Last Name:LIBERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SANDPIPER LN
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-2138
Mailing Address - Country:US
Mailing Address - Phone:585-381-2010
Mailing Address - Fax:
Practice Address - Street 1:9 SANDPIPER LN
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-2138
Practice Address - Country:US
Practice Address - Phone:585-381-2010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021683-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist