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Organization
LIBERTY PHARMACY INC.
Active
Organization
LIBERTY PHARMACY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AYESHA FURQUAN (PRESIDENT)
(718) 738-1500
Entity
Organization
Contact information
Practice address
12402A LIBERTY AVE, SOUTH RICHMOND HILL, NY 11419-2232
(718) 738-1500
Mailing address
12402A LIBERTY AVE, SOUTH RICHMOND HILL, NY 11419-2232
(718) 738-1500
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
031201
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
031201
NYS PHARMACY LICENSE
NY
Enumeration date
05/22/2012
Last updated
07/09/2012
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