Provider Demographics
NPI:1326194085
Name:ZIBERT PHARMACEUTICALS SERVICES PA
Entity Type:Organization
Organization Name:ZIBERT PHARMACEUTICALS SERVICES PA
Other - Org Name:MEDICINE SHOPPE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIBERT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:870-424-4010
Mailing Address - Street 1:116 HIGHWAY 201 N
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-3158
Mailing Address - Country:US
Mailing Address - Phone:870-424-4010
Mailing Address - Fax:870-425-2585
Practice Address - Street 1:116 HIGHWAY 201 N
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3158
Practice Address - Country:US
Practice Address - Phone:870-424-4010
Practice Address - Fax:870-425-2585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR07001183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR135857407Medicaid