Provider Demographics
NPI:1033719281
Name:LIEB, ERIC JOSEPH
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JOSEPH
Last Name:LIEB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 BEDFORD SQ
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:PA
Mailing Address - Zip Code:15537-6934
Mailing Address - Country:US
Mailing Address - Phone:814-623-1995
Mailing Address - Fax:814-623-2545
Practice Address - Street 1:72 BEDFORD SQ
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-6934
Practice Address - Country:US
Practice Address - Phone:814-623-1995
Practice Address - Fax:814-623-2545
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP042573L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist