Provider Demographics
NPI:1730260886
Name:LIEBMAN, ELLIOT (RPH)
Entity type:Individual
Prefix:
First Name:ELLIOT
Middle Name:
Last Name:LIEBMAN
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 1:5959 ASHCROFT DRIVE
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-3136
Mailing Address - Country:US
Mailing Address - Phone:440-449-6858
Mailing Address - Fax:440-442-4414
Practice Address - Street 1:10701 EAST BLVD.
Practice Address - Street 2:WADE PARK VETERANS MEDICAL CENTER
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1702
Practice Address - Country:US
Practice Address - Phone:216-791-3800
Practice Address - Fax:216-421-3022
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-11388183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist