Organization
LIBERTY DRUG INC
Active
Other names
LIBERTY DRUG INC
Organization subpart
No
Provider details
NPI number
Authorized official
TOBI NEIDY (MANAGER)
(405) 224-1204
Entity
Organization
Contact information
Practice address
315 W CHICKASHA AVE, CHICKASHA, OK 73018-2652
(405) 224-1204
(405) 224-1208
Mailing address
315 W CHICKASHA AVE, CHICKASHA, OK 73018-2652
(405) 224-1204
(405) 224-1208
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
18-437
OK
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100223170A
—
OK
01
—
2072556
PK
—
Enumeration date
11/01/2006
Last updated
01/13/2017
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