Liberty Drug Store, Inc.

Primary specialty

PharmacistTaxonomy code 183500000X

License

T08879 Issued in MS

Legal business name

LIBERTY DRUG STORE, INC.

Practice address

110 E Main St
Liberty, MS 39645

Phone

(601) 657-8051

Fax

(601) 657-8049

NPI assigned

May 23, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ronald Evans Blalock

Title

President/Pharmacist

Phone

(601) 657-8051

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Matthew Blalock, PHARMD

  • Pharmacist
  • Liberty, MS
  • NPI 1851115547
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701907200000",
    "number": "1639124183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 217",
            "city": "LIBERTY",
            "state": "MS",
            "postal_code": "396450217",
            "telephone_number": "601-657-8051",
            "fax_number": "601-657-8049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 E MAIN ST",
            "city": "LIBERTY",
            "state": "MS",
            "postal_code": "39645",
            "telephone_number": "601-657-8051",
            "fax_number": "601-657-8049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY DRUG STORE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2023-12-07",
        "certification_date": "2023-12-07",
        "status": "A",
        "authorized_official_last_name": "BLALOCK",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "EVANS",
        "authorized_official_title_or_position": "PRESIDENT/PHARMACIST",
        "authorized_official_telephone_number": "601-657-8051"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "MS",
            "license": "T08879",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00330466",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00440833",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Leonna Huhn, NP
• Wykeshia V Jones-Wilson, CCSS
• Elissa Jones, PT
• Lee D. Casey D.M.D., LLC
• Annie Cardenas Leger, RDH
• Evelyn Jeanette Love, MA
• Trinity McKenzie, M.D.
• Mississippi State Department of Health
• Leslie Odom
• Hannah Page

• All providers in Liberty, MS
• Pharmacist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.