Provider Demographics
NPI:1730785817
Name:LALIBERTE, RICHARD EDWARD (BSC PHARM)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:EDWARD
Last Name:LALIBERTE
Suffix:
Gender:M
Credentials:BSC PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 N WICKHAM RD # NO00573
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-8104
Mailing Address - Country:US
Mailing Address - Phone:321-259-2333
Mailing Address - Fax:
Practice Address - Street 1:1800 N WICKHAM RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8104
Practice Address - Country:US
Practice Address - Phone:321-259-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-05
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS25877183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS25977OtherPHARMACIST