Provider Demographics
NPI:1124187802
Name:GEAN COMPANIES-CLIFTON, LLC
Entity Type:Organization
Organization Name:GEAN COMPANIES-CLIFTON, LLC
Other - Org Name:WILLOUGHBY DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MCBATH
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:931-676-3318
Mailing Address - Street 1:PO BOX 194
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:TN
Mailing Address - Zip Code:38425
Mailing Address - Country:US
Mailing Address - Phone:931-676-3318
Mailing Address - Fax:931-676-3450
Practice Address - Street 1:104 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:TN
Practice Address - Zip Code:38425
Practice Address - Country:US
Practice Address - Phone:931-676-3318
Practice Address - Fax:931-676-3450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
183500000X, 332B00000X, 333600000X, 3336C0004X
TN12543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding PharmacyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3452202Medicaid
2095243OtherPK
TNQ046458Medicaid