Liberty Healthcare Pharmacy of Nevada LLC

Primary specialty

Mail Order PharmacyTaxonomy code 3336M0002X

License

PH02204 Issued in NV

Legal business name

LIBERTY HEALTHCARE PHARMACY OF NEVADA LLC

Practice address

6225 Annie Oakley Dr
Suite 100
Las Vegas, NV 89120-3914

Phone

(800) 491-3276

Fax

(877) 592-8466

NPI assigned

Dec 17, 2008

Organization subpart

Yes

Parent organization

LIBERTY HEALTHCARE GROUP, INC.As reported in NPPES

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

Authorized official

Name

Mr. Keith Jones

Title

President, Director

Phone

(772) 398-5800

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1229472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1962648261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8881 LIBERTY LN",
            "address_2": "ATTN;COMPLIANCE",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349523477",
            "telephone_number": "772-398-5800",
            "fax_number": "772-398-2192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6225 ANNIE OAKLEY DR",
            "address_2": "SUITE 100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891203914",
            "telephone_number": "800-491-3276",
            "fax_number": "877-592-8466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY HEALTHCARE PHARMACY OF NEVADA LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIBERTY HEALTHCARE GROUP, INC.",
        "enumeration_date": "2008-12-17",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "PRESIDENT, DIRECTOR",
        "authorized_official_telephone_number": "772-398-5800",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336M0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Mail Order Pharmacy",
            "state": "NV",
            "license": "PH02204",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RESIDENT PHARMACY LICENSE",
            "identifier": "PH02204",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "2991520",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Liberty Behavioral Consultants
• Liberty Behavioral Consultants
• Liberty Creek Hospice, LLC
• Liberty Dental Plan of Nevada, Inc.
• Liberty Dental Plan of Nevada, Inc.
• Liberty Wellness Outpatient Counseling
• Diana Badeo Libiran
• William Adam Libling, DO, MS
• Gianna Nicole Libonati
• Jerrod Paul Libonati, RD

• Mail Order Pharmacy in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Mail Order Pharmacy in Nevada

• 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.