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General NPI Number Information
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NPI Number | 1073685574
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Entity Type | Organization
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Legal Business Name | CLINICAL SPECIALTIES LLC
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3708 EXECUTIVE CENTER DR STE A
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City | AUGUSTA
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State | GA
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Zip | 30907-0956
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Country | US
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Telephone | 706-855-1915
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Fax | 706-855-1456
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Provider Business Mailing Address
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Address Line | 880 HICKORY RIDGE RD
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City | AIKEN
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State | SC
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Zip | 29803-7362
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Country | US
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Telephone | 706-855-1915
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Fax | 706-855-1456
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Authorized Official
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Title or Position | OWNER
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Name | AUSTIN E GORE
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Credential | RPH
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Telephone | 706-855-1915
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PHRE008682
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License Number State | GA
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