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Organization
LIBERTY PHARMACY INC
Active
Organization
LIBERTY PHARMACY INC
Active
Other names
Liberty Pharmacy Inc
Organization subpart
No
Provider details
NPI number
Authorized official
GOERGE ESHO (PRESIDENT)
(313) 841-1990
Entity
Organization
Contact information
Practice address
4802 W VERNOR HWY, DETROIT, MI 48209-2122
(313) 841-1990
(313) 841-6966
Mailing address
4802 W VERNOR HWY, DETROIT, MI 48209-2122
(313) 841-1990
(313) 841-6966
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336L0003X
Long Term Care Pharmacy
Primary
5301006438
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1326143603
—
MI
01
—
2177576
PK
—
Enumeration date
06/06/2018
Last updated
06/06/2018
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