Organization
LIBERTY DRUG STORE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD EVANS BLALOCK (PRESIDENT/PHARMACIST)
(601) 657-8051
Entity
Organization
Contact information
Practice address
110 E MAIN ST, LIBERTY, MS 39645
(601) 657-8051
(601) 657-8049
Mailing address
PO BOX 217, LIBERTY, MS 39645-0217
(601) 657-8051
(601) 657-8049
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
T08879
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00330466
—
MS
05
—
00440833
—
MS
Enumeration date
05/23/2006
Last updated
12/07/2023
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