# CLB PHARMACY GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Friendly City Pharmacy on 2nd, MOONS PHARMACY INC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598858508
- **Authorized official:** LUCAS BROWN (OWNER)
- **Authorized official phone:** (229) 563-6689

## Contact information

- **Practice address:** 717 2ND ST W, TIFTON, GA 31794-4201
- **Practice address phone:** (229) 382-3711
- **Practice address fax:** (229) 387-7521
- **Mailing address:** 717 2ND ST W, TIFTON, GA 31794-4201
- **Mailing address phone:** (229) 382-3711
- **Mailing address fax:** (229) 387-7521

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | PHRE003394 | GA | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 10/02/2006
- **Last updated:** 06/28/2024