Organization Name: | LIBERTY COMPOUNDING PHARMACY, LLC |
NPI Number: | 1144406703 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TIMOTHY J KIRK (OWNER) |
Mailing Address: | 7355 Lewis Ave Suite D Temperance |
State: | MI US |
Postal Code: | 48182 |
Phone Number: | 7348478888 |
Fax Number: | 7348478884 |
NPI Enumeration Date: | 01/14/2008 |
NPI Last Update Date: | 01/14/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 3336C0004X |
License Number: | 5301008780 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Pharmacy |
Taxonomy Specialization: | Compounding Pharmacy |
Taxonomy Definition: | A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner |