Organization
LIBERTY MEDICAL, LLC
Active
Parent organization
LIBERTY MEDICAL HOLDINGS, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
LIBERTY MEDICAL HOLDINGS, LLC
Authorized official
JONATHAN BLACK (PRESIDENT)
(772) 398-5800
Entity
Organization
Contact information
Practice address
8881 LIBERTY LN, PORT SAINT LUCIE, FL 34952-3477
(800) 491-3276
(877) 592-8466
Mailing address
8881 LIBERTY LN, ATTN: LICENSING, PORT SAINT LUCIE, FL 34952-3477
(772) 398-5800
(844) 363-4341
Taxonomy
Speciality
Code
Description
License number
State
3336M0002X
Mail Order Pharmacy
Primary
PH28876
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1045118
NCPDP
—
01
—
PH28876
RESIDENT BOARD OF PHARMACY LICENSE
FL
Enumeration date
04/17/2009
Last updated
03/07/2023
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