Organization
LIBERTY HOME PHARMACY CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT N MARK (PRESIDENT)
(772) 398-5800
Entity
Organization
Contact information
Practice address
8881 LIBERTY LN, PORT ST LUCIE, FL 34952-3477
(877) 891-2545
(877) 891-2546
Mailing address
PO BOX 20003, FORT PIERCE, FL 34979-0003
(877) 891-2545
(877) 891-2546
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0001035416
—
DE
05
—
00864432A
—
GA
05
—
0548313
—
IA
05
—
1268330
—
LA
05
—
514902
—
AZ
05
—
51901902
—
HI
05
—
73850080
—
CO
05
—
90002262
—
KY
05
—
MS383FL
—
AK
Enumeration date
10/31/2005
Last updated
08/22/2020
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