Organization
CLB PHARMACY GROUP LLC
Active
Other names
Friendly City Pharmacy on 2nd, MOONS PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
LUCAS BROWN (OWNER)
(229) 563-6689
Entity
Organization
Contact information
Practice address
717 2ND ST W, TIFTON, GA 31794-4201
(229) 382-3711
(229) 387-7521
Mailing address
717 2ND ST W, TIFTON, GA 31794-4201
(229) 382-3711
(229) 387-7521
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
PHRE003394
GA
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00033855A
—
GA
05
—
00033855B
—
GA
01
—
2012857
PK
—
Enumeration date
10/02/2006
Last updated
06/28/2024
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