Healthcare Provider Details

I. General information

NPI: 1912694589
Provider Name (Legal Business Name): CARRIE LOUISE BROWN LIEBTAG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARRIE LOUISE BROWN

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 04/24/2023
Certification Date: 04/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHILDRENS DR
COLUMBUS OH
43205-2664
US

IV. Provider business mailing address

5735 WILLOWCREEK CIR
COLUMBUS OH
43213-2680
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-2151
  • Fax:
Mailing address:
  • Phone: 614-448-6258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03326968
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: