Provider Demographics
NPI:1851306492
Name:LION COUNTRY PHARMACY, LLC
Entity Type:Organization
Organization Name:LION COUNTRY PHARMACY, LLC
Other - Org Name:DUFFEY DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PHARMACIST-IN-CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, RPH
Authorized Official - Phone:979-828-3536
Mailing Address - Street 1:PO BOX 639
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TX
Mailing Address - Zip Code:77856-0639
Mailing Address - Country:US
Mailing Address - Phone:979-828-3536
Mailing Address - Fax:979-828-3543
Practice Address - Street 1:311 N CENTER
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TX
Practice Address - Zip Code:77856
Practice Address - Country:US
Practice Address - Phone:979-828-3536
Practice Address - Fax:979-828-3543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
183500000X
TX198713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149968Medicaid
4519798OtherNCPDP PROVIDER IDENTIFICATION NUMBER