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General NPI Number Information
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NPI Number | 1598068967
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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 | 12/07/2010
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Last Update Date | 12/07/2010
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Provider Practice Location Address
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Address Line | 318 BASTON RD SUITE 103
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City | AUGUSTA
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State | GA
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Zip | 30907-2978
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Country | US
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Telephone | 706-855-1915
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Fax |
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Provider Business Mailing Address
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Address Line | 318 BASTON RD SUITE 103
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City | AUGUSTA
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State | GA
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Zip | 30907-2978
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Country | US
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Telephone | 706-855-1915
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Fax |
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Authorized Official
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Title or Position | OWNER/ PIC
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Name | DR. AUSTIN EUGENE GORE
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Credential | PHARMD
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHRE008682
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License Number State | GA
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