NPIMap

Organization Active NPI

Liberty Pharmacy Inc.

  • Pharmacy
  • South Richmond Hill, NY
National Provider Identifier
1093075236
Registry record updated Jul 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
031201 Issued in NY
Legal business name
LIBERTY PHARMACY INC.
Practice address
12402A Liberty Ave
South Richmond Hill, NY 11419-2232
Phone
(718) 738-1500
NPI assigned
May 22, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ayesha Furquan
Title
President
Phone
(718) 738-1500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 031201 NY Primary

Addresses

Primary practice location

12402A Liberty Ave
South Richmond Hill, NY 11419-2232

Mailing address

12402A Liberty Ave
South Richmond Hill, NY 11419-2232
Phone (718) 738-1500

Other identifiers 1

IdentifierTypeStateIssuer
031201OtherNYNYS PHARMACY LICENSE

National Provider Directory

National Provider Directory

Locations

12402A Liberty Ave
South Richmond Hill, NY 11419
Phone (718) 738-1500

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1337644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341792000000",
    "number": "1093075236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12402A LIBERTY AVE",
            "city": "SOUTH RICHMOND HILL",
            "state": "NY",
            "postal_code": "114192232",
            "telephone_number": "718-738-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12402A LIBERTY AVE",
            "city": "SOUTH RICHMOND HILL",
            "state": "NY",
            "postal_code": "114192232",
            "telephone_number": "718-738-1500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY PHARMACY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-22",
        "last_updated": "2012-07-09",
        "status": "A",
        "authorized_official_last_name": "FURQUAN",
        "authorized_official_first_name": "AYESHA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-738-1500"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "031201",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NYS PHARMACY LICENSE",
            "identifier": "031201",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Richmond Hill, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.