Healthcare Provider Details

I. General information

NPI: 1598769531
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: 01/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 S MAIN ST
MILBANK SD
57252-1806
US

IV. Provider business mailing address

109 S MAIN ST
MILBANK SD
57252-1806
US

V. Phone/Fax

Practice location:
  • Phone: 605-432-5541
  • Fax: 605-432-6258
Mailing address:
  • Phone: 605-432-5541
  • Fax: 605-432-6258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number100-0487
License Number StateSD

VIII. Authorized Official

Name: MR. PAUL A SINCLAIR
Title or Position: VICE PRESIDENT
Credential: RPH
Phone: 605-432-5541