Provider Demographics
NPI:1043827157
Name:LIEB, NATHAN ALAN (RPH)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:ALAN
Last Name:LIEB
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15496 SHALESIDE CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-8389
Mailing Address - Country:US
Mailing Address - Phone:814-381-4719
Mailing Address - Fax:
Practice Address - Street 1:15501 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3851
Practice Address - Country:US
Practice Address - Phone:216-226-7961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03440236183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist