Individual provider Active NPI

Paul Liberty, RPH

  • Pharmacist
  • Guilford, CT
National Provider Identifier
1104583574
Registry record updated Nov 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
PCT.06225 Issued in CT
Practice address
1057 Boston Post Rd Ste 2
Guilford, CT 06437-2672
Phone
(203) 458-1444
Fax
(203) 458-2182
NPI assigned
Nov 20, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 20, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X PCT.06225 CT Primary

Addresses

Primary practice location

1057 Boston Post Rd Ste 2
Guilford, CT 06437-2672

Mailing address

1057 Boston Post Rd Ste 2
Guilford, CT 06437-2672
Phone (203) 458-1444

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
PCT.06225CTMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1637366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637366400000",
    "number": "1104583574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1057 BOSTON POST RD STE 2",
            "city": "GUILFORD",
            "state": "CT",
            "postal_code": "064372672",
            "telephone_number": "203-458-1444",
            "fax_number": "203-458-2182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1057 BOSTON POST RD STE 2",
            "city": "GUILFORD",
            "state": "CT",
            "postal_code": "064372672",
            "telephone_number": "203-458-1444",
            "fax_number": "203-458-2182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIBERTY",
        "first_name": "PAUL",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-11-20",
        "last_updated": "2021-11-20",
        "certification_date": "2021-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CT",
            "license": "PCT.06225",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Guilford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2021; 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.