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General NPI Number Information
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NPI Number | 1386998623
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Entity Type | Organization
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Legal Business Name | LBG HOLDINGS LLC
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Dates
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Enumeration Date | 11/08/2012
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Last Update Date | 11/15/2016
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Provider Practice Location Address
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Address Line | 2864 W MAIN ST
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City | LEESBURG
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State | FL
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Zip | 34748-4631
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Country | US
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Telephone | 352-315-1200
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Fax | 352-315-1201
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Provider Business Mailing Address
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Address Line | PO BOX 621255
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City | OVIEDO
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State | FL
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Zip | 32762-1255
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Country | US
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Telephone | 352-315-1200
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Fax | 352-315-1201
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | LARRY HOWARD
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Credential |
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Telephone | 407-929-2552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | PH30115
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License Number State | FL
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