Provider Demographics
NPI:1982765020
Name:LIBERTY DISCOUNT DRUGS, INC.
Entity Type:Organization
Organization Name:LIBERTY DISCOUNT DRUGS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:H
Authorized Official - Last Name:ESHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-554-3900
Mailing Address - Street 1:4802 W VERNOR HWY
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48209-2122
Mailing Address - Country:US
Mailing Address - Phone:313-554-3900
Mailing Address - Fax:313-841-6966
Practice Address - Street 1:4802 W VERNOR HWY
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48209-2122
Practice Address - Country:US
Practice Address - Phone:313-554-3900
Practice Address - Fax:313-841-6966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010045861835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatricGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2341650OtherNCPDP
MI1788281Medicaid
MIBL9711498OtherDEA NUMBER