Healthcare Provider Details

I. General information

NPI: 1447632641
Provider Name (Legal Business Name): TLC PHARMACY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2015
Last Update Date: 06/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5231 CLEVELAND HWY
CLERMONT GA
30527-2205
US

IV. Provider business mailing address

PO BOX 410
CLERMONT GA
30527-0410
US

V. Phone/Fax

Practice location:
  • Phone: 770-983-1495
  • Fax: 770-983-9580
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPHRE008047
License Number StateGA

VIII. Authorized Official

Name: RONNIE CAIN
Title or Position: PRESIDENT
Credential:
Phone: 770-983-1495