Healthcare Provider Details

I. General information

NPI: 1922117282
Provider Name (Legal Business Name): LOVVORN DRUG COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 ALABAMA AVE S
BREMEN GA
30110-2006
US

IV. Provider business mailing address

PO BOX 603
BREMEN GA
30110-0603
US

V. Phone/Fax

Practice location:
  • Phone: 770-537-8889
  • Fax: 770-537-8817
Mailing address:
  • Phone: 770-537-8889
  • Fax: 770-537-8817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE008702
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. BRANDALL S LOVVORN
Title or Position: OWNER/PHARMACIST
Credential: PHARM.D
Phone: 770-537-8889