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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