Healthcare Provider Details

I. General information

NPI: 1861496895
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: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 2ND ST NW
ORTONVILLE MN
56278-1409
US

IV. Provider business mailing address

146 2ND ST NW
ORTONVILLE MN
56278-1409
US

V. Phone/Fax

Practice location:
  • Phone: 320-839-3825
  • Fax:
Mailing address:
  • Phone: 320-839-3825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number260519-9
License Number StateMN

VIII. Authorized Official

Name: MR. ERIC MARLO BRANDREIT
Title or Position: PHARMACIST-PHARM D
Credential:
Phone: 320-839-3825