Healthcare Provider Details

I. General information

NPI: 1356345896
Provider Name (Legal Business Name): LIEBE DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 4TH BROADWAY
BROWNS VALLEY MN
56219-0256
US

IV. Provider business mailing address

PO BOX K
BROWNS VALLEY MN
56219-0256
US

V. Phone/Fax

Practice location:
  • Phone: 320-695-2331
  • Fax: 320-695-2518
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number260235
License Number StateMN

VIII. Authorized Official

Name: ELLEN JOHNSON
Title or Position: MANAGER PHARMCIST
Credential:
Phone: 320-695-2331