Provider Demographics
NPI:1912694589
Name:LIEBTAG, CARRIE LOUISE BROWN (PHARMD)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:LOUISE BROWN
Last Name:LIEBTAG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:LOUISE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5735 WILLOWCREEK CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2680
Mailing Address - Country:US
Mailing Address - Phone:614-448-6258
Mailing Address - Fax:
Practice Address - Street 1:700 CHILDRENS DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2664
Practice Address - Country:US
Practice Address - Phone:614-722-2151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03326968183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist