Provider Demographics
NPI:1750889002
Name:LIBERTY DRUGS LLC
Entity type:Organization
Organization Name:LIBERTY DRUGS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MUFID
Authorized Official - Middle Name:
Authorized Official - Last Name:NAJJAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-820-0101
Mailing Address - Street 1:2411 WILLIAMS DR
Mailing Address - Street 2:STE 3
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-3271
Mailing Address - Country:US
Mailing Address - Phone:832-687-7167
Mailing Address - Fax:512-249-7512
Practice Address - Street 1:2411 WILLIAMS DR STE 3
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-3261
Practice Address - Country:US
Practice Address - Phone:512-820-0101
Practice Address - Fax:512-820-1244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-31
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX318353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149753Medicaid
2175845OtherPK