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Organization

LIBERTY DRUG STORE,INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. MACK A. EVANS D. PH. (OWNER)
(931) 762-6902
Entity
Organization

Contact information

Practice address
1400 N LOCUST AVE, LAWRENCEBURG, TN 38464-2210
(931) 762-6902
(931) 762-1985
Mailing address
1400 N LOCUST AVE, LAWRENCEBURG, TN 38464-2210
(931) 762-6902
(931) 762-1985

Taxonomy

Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
255
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
9441304
TN
Enumeration date
11/13/2006
Last updated
09/18/2008
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