Provider Demographics
NPI:1003500752
Name:LENLOCK RX, LLC DBA CLEBURNE PHARMACY
Entity Type:Organization
Organization Name:LENLOCK RX, LLC DBA CLEBURNE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:TANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-680-1997
Mailing Address - Street 1:21 BILL ROBISON PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36206-2624
Mailing Address - Country:US
Mailing Address - Phone:256-444-6282
Mailing Address - Fax:
Practice Address - Street 1:21 BILL ROBISON PKWY STE B
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36206-2624
Practice Address - Country:US
Practice Address - Phone:256-444-6282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-06
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy