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General NPI Number Information
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NPI Number | 1306700745
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Entity Type | Organization
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Legal Business Name | CLAIBORNE DRUGSTORE LLC
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Dates
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Enumeration Date | 12/10/2025
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 822 W MAIN ST STE A
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City | HOMER
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State | LA
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Zip | 71040-3324
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Country | US
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Telephone | 318-927-6089
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Fax | 318-252-3212
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Provider Business Mailing Address
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Address Line | 822 W MAIN ST STE A
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City | HOMER
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State | LA
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Zip | 71040-3324
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Country | US
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Telephone | 318-927-6089
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Fax | 318-252-3212
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Authorized Official
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Title or Position | OWNER
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Name | OLUWAFEMI ADEGBOYEGA
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Credential |
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Telephone | 708-945-0269
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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