Provider Demographics
NPI:1669468294
Name:FOUR C, LLC
Entity Type:Organization
Organization Name:FOUR C, LLC
Other - Org Name:GROW DRUG CO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANNA
Authorized Official - Middle Name:H
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:229-758-3316
Mailing Address - Street 1:207 W GEER ST
Mailing Address - Street 2:
Mailing Address - City:COLQUITT
Mailing Address - State:GA
Mailing Address - Zip Code:39837-3533
Mailing Address - Country:US
Mailing Address - Phone:229-758-3316
Mailing Address - Fax:229-758-6343
Practice Address - Street 1:207 W GEER ST
Practice Address - Street 2:
Practice Address - City:COLQUITT
Practice Address - State:GA
Practice Address - Zip Code:39837-3533
Practice Address - Country:US
Practice Address - Phone:229-758-3316
Practice Address - Fax:229-758-6343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE004475332B00000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1107906OtherNABP
1107906OtherNABP