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Contact Information

LIBERTY DRUG STORE, INC.
110 E MAIN ST
LIBERTY, MS39645
 Phone: 601-657-8051
 Fax: 601-657-8049
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pharmacist

183500000X
Indicates primary specialty

NPI Profile & details for LIBERTY DRUG STORE, INC.

NPI Number 1639124183
LBN Legal business name LIBERTY DRUG STORE, INC.
Authorized official RONALD BLALOCK - (PRESIDENT/PHARMACIST)
Entity Organization
Organization subpart 1 No
Enumeration date 05/23/2006
Last updated 12/07/2023 - About 2 years ago
Identifiers
MS License # T08879
MS Medicaid 00330466
MS Medicaid 00440833
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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