Healthcare Provider Details

I. General information

NPI: 1306700745
Provider Name (Legal Business Name): CLAIBORNE DRUGSTORE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 W MAIN ST STE A
HOMER LA
71040-3324
US

IV. Provider business mailing address

822 W MAIN ST STE A
HOMER LA
71040-3324
US

V. Phone/Fax

Practice location:
  • Phone: 318-927-6089
  • Fax: 318-252-3212
Mailing address:
  • Phone: 318-927-6089
  • Fax: 318-252-3212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: OLUWAFEMI ADEGBOYEGA
Title or Position: OWNER
Credential:
Phone: 708-945-0269