Provider Demographics
NPI:1982821237
Name:LIBBY DRUG P.C
Entity Type:Organization
Organization Name:LIBBY DRUG P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY TECHNICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JAQUETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-293-3958
Mailing Address - Street 1:906 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:LIBBY
Mailing Address - State:MT
Mailing Address - Zip Code:59923-2014
Mailing Address - Country:US
Mailing Address - Phone:406-293-3958
Mailing Address - Fax:406-293-5858
Practice Address - Street 1:906 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-2014
Practice Address - Country:US
Practice Address - Phone:406-293-3958
Practice Address - Fax:406-293-5858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8843336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0220201Medicaid
MT0220201Medicaid