Organization
LIBRA HEALTHCARE LLC
Active
Organization
LIBRA HEALTHCARE LLC
Active
Other names
Medicine Shoppe
Organization subpart
No
Provider details
NPI number
Authorized official
DENA FERMAN (THIRD PARTY PLAN COORDINATOR)
(314) 993-6000
Entity
Organization
Contact information
Practice address
1232 8TH ST, DAYTONA BEACH, FL 32117-4009
(386) 238-3777
(386) 238-3343
Mailing address
1232 8TH ST, DAYTONA BEACH, FL 32117-4009
(386) 238-3777
(386) 238-3343
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
FL
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336C0004X
Compounding Pharmacy
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1028112
NCPDP
FL
01
—
PH22899
STATE LICENSE
FL
Enumeration date
08/27/2007
Last updated
03/07/2023
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