Organization
LIBERTY PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GEORGE HANNA ESHO (PRESIDENT)
(313) 841-1990
Entity
Organization
Contact information
Practice address
4802 W VERNOR HWY, DETROIT, MI 48209-2122
(313) 841-1990
(313) 941-6966
Mailing address
4802 W VERNOR HWY, DETROIT, MI 48209-2122
(313) 841-1990
(313) 841-6966
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5301006438
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H22563
BLUE CROSS BLUE SHIELD
MI
05
—
3272292
—
MI
05
—
3272800
—
MI
Enumeration date
09/13/2006
Last updated
08/08/2016
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