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General NPI Number Information
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NPI Number | 1477631984
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Entity Type | Organization
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Legal Business Name | LIBERTY DRUG INC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 01/13/2017
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Provider Practice Location Address
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Address Line | 315 W CHICKASHA AVE
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City | CHICKASHA
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State | OK
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Zip | 73018-2652
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Country | US
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Telephone | 405-224-1204
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Fax | 405-224-1208
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Provider Business Mailing Address
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Address Line | 315 W CHICKASHA AVE
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City | CHICKASHA
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State | OK
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Zip | 73018-2652
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Country | US
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Telephone | 405-224-1204
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Fax | 405-224-1208
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Authorized Official
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Title or Position | MANAGER
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Name | TOBI NEIDY
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Credential |
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Telephone | 405-224-1204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 18-437
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License Number State | OK
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