Liberty Medical, LLC

Primary specialty

Mail Order PharmacyTaxonomy code 3336M0002X

License

PH28876 Issued in FL

Legal business name

LIBERTY MEDICAL, LLC

Practice address

8881 Liberty LN
Port Saint Lucie, FL 34952-3477

Phone

(800) 491-3276

Fax

(877) 592-8466

NPI assigned

Apr 17, 2009

Organization subpart

Yes

Parent organization

LIBERTY MEDICAL HOLDINGS, LLCAs reported in NPPES

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

Authorized official

Name

Jonathan Black

Title

President

Phone

(772) 398-5800

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1239926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1649413832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8881 LIBERTY LN",
            "address_2": "ATTN: LICENSING",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349523477",
            "telephone_number": "772-398-5800",
            "fax_number": "844-363-4341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8881 LIBERTY LN",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349523477",
            "telephone_number": "800-491-3276",
            "fax_number": "877-592-8466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY MEDICAL, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIBERTY MEDICAL HOLDINGS, LLC",
        "enumeration_date": "2009-04-17",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "772-398-5800"
    },
    "taxonomies": [
        {
            "code": "3336M0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Mail Order Pharmacy",
            "state": "FL",
            "license": "PH28876",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "1045118",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RESIDENT BOARD OF PHARMACY LICENSE",
            "identifier": "PH28876",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lucian Maurice Lewis IV
• Shaun E Leydon
• Dalia Leyva Perez, FNP, APRN
• Vicki Li, DPT
• Frank Liantonio III
• Brett Lieberman
• Life Long Learning Center 2
• Lifeforce Pediatric Therapy
• Lifelong Health LLC
• Pauline Lilley-Harvey

• Mail Order Pharmacy in Port Saint Lucie, FL
• Providers in Port Saint Lucie, FL by specialty
• Mail Order Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.