Provider Demographics
NPI:1043561392
Name:CB PHARMACY INC
Entity Type:Organization
Organization Name:CB PHARMACY INC
Other - Org Name:CASTLEBERRY DRUG COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:TYREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-505-9120
Mailing Address - Street 1:67 N LEE ST
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:GA
Mailing Address - Zip Code:31029-2133
Mailing Address - Country:US
Mailing Address - Phone:760-505-9120
Mailing Address - Fax:866-310-6445
Practice Address - Street 1:67 N LEE ST
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:GA
Practice Address - Zip Code:31029-2133
Practice Address - Country:US
Practice Address - Phone:760-505-9120
Practice Address - Fax:866-310-6445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-26
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0098363336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA7228350001Medicare NSC