Organization
LIBERTY HEALTHCARE PHARMACY OF NEVADA LLC
Active
Parent organization
LIBERTY HEALTHCARE GROUP, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
LIBERTY HEALTHCARE GROUP, INC.
Authorized official
MR. KEITH JONES (PRESIDENT, DIRECTOR)
(772) 398-5800
Entity
Organization
Contact information
Practice address
6225 ANNIE OAKLEY DR, SUITE 100, LAS VEGAS, NV 89120-3914
(800) 491-3276
(877) 592-8466
Mailing address
8881 LIBERTY LN, ATTN;COMPLIANCE, PORT ST LUCIE, FL 34952-3477
(772) 398-5800
(772) 398-2192
Taxonomy
Speciality
Code
Description
License number
State
3336M0002X
Mail Order Pharmacy
Primary
PH02204
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2991520
NCPDP
—
01
—
PH02204
RESIDENT PHARMACY LICENSE
NV
Enumeration date
12/17/2008
Last updated
03/07/2023
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