Healthcare Provider Details

I. General information

NPI: 1306929468
Provider Name (Legal Business Name): LINCOLNTON INVESTMENTS LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 N WASHINGTON ST
LINCOLNTON GA
30817
US

IV. Provider business mailing address

PO BOX 1839
LINCOLNTON GA
30817-8839
US

V. Phone/Fax

Practice location:
  • Phone: 706-359-3343
  • Fax: 706-359-7505
Mailing address:
  • Phone: 706-359-3343
  • Fax: 706-359-7505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE010650
License Number StateGA

VIII. Authorized Official

Name: BRYCE ALLFREY
Title or Position: PIC
Credential: PHARMD
Phone: 706-359-3343