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General NPI Number Information
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NPI Number | 1073334876
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Entity Type | Organization
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Legal Business Name | CLB PHARMACY GROUP LLC
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Dates
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Enumeration Date | 10/23/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 717 2ND STREET W
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City | TIFTON
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State | GA
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Zip | 31794
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Country | US
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Telephone | 229-382-3711
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Fax |
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Provider Business Mailing Address
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Address Line | 717 2ND STREET W
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City | TIFTON
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State | GA
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Zip | 31794
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LUCAS BROWN
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Credential |
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Telephone | 229-563-6689
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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