Provider Demographics
NPI:1295373165
Name:CEFALU RX LLC
Entity Type:Organization
Organization Name:CEFALU RX LLC
Other - Org Name:TABOR DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CEFALU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-773-5363
Mailing Address - Street 1:16575 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39339
Mailing Address - Country:US
Mailing Address - Phone:662-773-5363
Mailing Address - Fax:662-773-9951
Practice Address - Street 1:16575 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:MS
Practice Address - Zip Code:39339
Practice Address - Country:US
Practice Address - Phone:662-773-5363
Practice Address - Fax:662-773-9951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-11
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy