Provider Demographics
NPI:1427138536
Name:LIEBNER, PETER KLAUS (RPH)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:KLAUS
Last Name:LIEBNER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 N MACOMB ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162
Mailing Address - Country:US
Mailing Address - Phone:734-240-4100
Mailing Address - Fax:734-240-4110
Practice Address - Street 1:730 N MACOMB ST
Practice Address - Street 2:SUITE 305
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162
Practice Address - Country:US
Practice Address - Phone:734-240-4100
Practice Address - Fax:734-240-4110
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027371183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2349783OtherNABP
MI2825862Medicaid
MI2825862Medicaid
2349783OtherNABP