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General NPI Number Information
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NPI Number | 1679449292
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Entity Type | Organization
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Legal Business Name | SUGARSPOON, LLC
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Dates
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Enumeration Date | 10/13/2025
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 12151 MAIN ST
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City | MASON
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State | TN
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Zip | 38049-7049
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Country | US
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Telephone | 901-698-8380
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Fax |
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Provider Business Mailing Address
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Address Line | 291 W HARMONY DR
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City | MASON
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State | TN
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Zip | 38049-5704
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Country | US
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Telephone | 901-481-8107
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | DR. KENEKO CLAYBON
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Credential | PHARM D
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Telephone | 901-481-8107
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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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