Provider Demographics
NPI:1710973573
Name:CLEBURNE DRUG INC
Entity Type:Organization
Organization Name:CLEBURNE DRUG INC
Other - Org Name:CLEBURNE DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-645-2415
Mailing Address - Street 1:310 N RIDGEWAY DR
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-5102
Mailing Address - Country:US
Mailing Address - Phone:817-645-2415
Mailing Address - Fax:817-645-7176
Practice Address - Street 1:310 N RIDGEWAY DR
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-5102
Practice Address - Country:US
Practice Address - Phone:817-645-2415
Practice Address - Fax:817-645-7176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336L0003X
TX21943336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111361501Medicaid
4515827OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TX016471701Medicaid
TX016471701Medicaid