# LIBERTY PHARMACY INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093075236
- **Authorized official:** AYESHA FURQUAN (PRESIDENT)
- **Authorized official phone:** (718) 738-1500

## Contact information

- **Practice address:** 12402A LIBERTY AVE, SOUTH RICHMOND HILL, NY 11419-2232
- **Practice address phone:** (718) 738-1500
- **Mailing address:** 12402A LIBERTY AVE, SOUTH RICHMOND HILL, NY 11419-2232
- **Mailing address phone:** (718) 738-1500

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | 031201 | NY | Yes |

## Other

- **Enumeration date:** 05/22/2012
- **Last updated:** 07/09/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 031201 | NYS PHARMACY LICENSE | NY |