Provider Demographics
NPI:1598769531
Name:LIEBE DRUG, INC.
Entity Type:Organization
Organization Name:LIEBE DRUG, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SINCLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:605-432-5541
Mailing Address - Street 1:109 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILBANK
Mailing Address - State:SD
Mailing Address - Zip Code:57252-1806
Mailing Address - Country:US
Mailing Address - Phone:605-432-5541
Mailing Address - Fax:605-432-6258
Practice Address - Street 1:109 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MILBANK
Practice Address - State:SD
Practice Address - Zip Code:57252-1806
Practice Address - Country:US
Practice Address - Phone:605-432-5541
Practice Address - Fax:605-432-6258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD100-0487333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD8500890Medicaid
4300098OtherNCPDP
SD8500890Medicaid