Healthcare Provider Details

I. General information

NPI: 1821092867
Provider Name (Legal Business Name): LIEBE DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 STUDDART AVE
GRACEVILLE MN
56240-7735
US

IV. Provider business mailing address

PO BOX 218
GRACEVILLE MN
56240-0218
US

V. Phone/Fax

Practice location:
  • Phone: 320-748-7112
  • Fax: 320-748-7228
Mailing address:
  • Phone: 320-748-7112
  • Fax: 320-748-7228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number261630
License Number StateMN

VIII. Authorized Official

Name: VALERIE TRITZ
Title or Position: RPH
Credential: RPH
Phone: 320-748-7112