Active NPI
Liberty Pharmacy Inc
- Community/Retail Pharmacy
- Detroit, MI
National Provider Identifier
1326143603
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 5301006438
- Legal business name
- LIBERTY PHARMACY INC
- Practice address
- 4802 W Vernor Hwy
Detroit, MI 48209-2122 - Phone
- (313) 841-1990
- Fax
- (313) 941-6966
- NPI assigned
- Sep 13, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. George Hanna Esho
- Title
- President
- Phone
- (313) 841-1990
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 5301006438 | MI | Primary |
Addresses
Primary practice location
4802 W Vernor Hwy
Detroit, MI 48209-2122
Mailing address
4802 W Vernor Hwy
Detroit, MI 48209-2122
Phone (313) 841-1990
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3272800 | Medicaid | MI | |
| 0H22563 | Other | MI | BLUE CROSS BLUE SHIELD |
| 3272292 | Medicaid | MI |
National Provider Directory
National Provider Directory- Tax ID family
- Liberty Pharmacy Inc
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Long Term Care Pharmacy
- Detroit, MI
- NPI 1750873535
Locations
4802 W Vernor Hwy
Detroit, MI 48209
Phone (313) 554-3900
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158105600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1470614400000",
"number": "1326143603",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4802 W VERNOR HWY",
"city": "DETROIT",
"state": "MI",
"postal_code": "482092122",
"telephone_number": "313-841-1990",
"fax_number": "313-841-6966"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4802 W VERNOR HWY",
"city": "DETROIT",
"state": "MI",
"postal_code": "482092122",
"telephone_number": "313-841-1990",
"fax_number": "313-941-6966"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LIBERTY PHARMACY INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-13",
"last_updated": "2016-08-08",
"status": "A",
"authorized_official_last_name": "ESHO",
"authorized_official_first_name": "GEORGE",
"authorized_official_middle_name": "HANNA",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "313-841-1990",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "MI",
"license": "5301006438",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3272800",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "0H22563",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3272292",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.