Provider Demographics
NPI:1265169262
Name:LIBERTY RX PHARMACY LLC
Entity type:Organization
Organization Name:LIBERTY RX PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SARKIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUDYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-777-8990
Mailing Address - Street 1:2458 ERRINGER RD
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-2351
Mailing Address - Country:US
Mailing Address - Phone:805-977-6337
Mailing Address - Fax:
Practice Address - Street 1:2458 ERRINGER RD
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-2351
Practice Address - Country:US
Practice Address - Phone:805-977-6337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy