Organization
L M BASS LLC
Active
Other names
Max Brown Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BLAKELY SUTTON DENNARD RPH (OWNER)
(912) 529-4545
Entity
Organization
Contact information
Practice address
809 N JEFFERSON STREET, DUBLIN, GA 31021-6305
(478) 272-8086
(478) 274-1171
Mailing address
794 SECOND STREET, SOPERTON, GA 30457
(912) 529-4545
(912) 529-6161
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000031413A
—
GA
01
—
1109405
NABP NUMBER
—
Enumeration date
05/11/2006
Last updated
11/16/2022
Update your record
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