Liberty Drug Store, Inc.
NPI 1639124183ActiveOrganization· Pharmacist· Liberty, MS
Pharmacist in Liberty, Mississippi, registered in NPPES in May 2006. The authorized official on file is Ronald Evans Blalock, President/Pharmacist. Enrolled in Medicare as dme supplier - pharmacy.
Overview
| NPI | 1639124183 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | May 23, 2006 |
| Last updated in NPPES | Dec 7, 2023 |
| Certified by provider | Dec 7, 2023 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Pharmacist Primary | 183500000X | T08879 | MS |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled DME Supplier - Pharmacy (MS) |
|---|
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