Provider Demographics
NPI:1861496895
Name:LIEBE DRUG, INC.
Entity Type:Organization
Organization Name:LIEBE DRUG, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-PHARM D
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:MARLO
Authorized Official - Last Name:BRANDREIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-839-3825
Mailing Address - Street 1:146 2ND ST NW
Mailing Address - Street 2:
Mailing Address - City:ORTONVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56278-1409
Mailing Address - Country:US
Mailing Address - Phone:320-839-3825
Mailing Address - Fax:
Practice Address - Street 1:146 2ND ST NW
Practice Address - Street 2:
Practice Address - City:ORTONVILLE
Practice Address - State:MN
Practice Address - Zip Code:56278-1409
Practice Address - Country:US
Practice Address - Phone:320-839-3825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN260519-9333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
24-18475OtherNCPDP
0335340003Medicare ID - Type Unspecified