Provider Demographics
NPI:1013255389
Name:CLARKESVILLE DRUG COMPOUNDING
Entity Type:Organization
Organization Name:CLARKESVILLE DRUG COMPOUNDING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDBETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-754-3763
Mailing Address - Street 1:596 W LOUISE ST
Mailing Address - Street 2:
Mailing Address - City:CLARKESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30523-5849
Mailing Address - Country:US
Mailing Address - Phone:706-754-3763
Mailing Address - Fax:706-839-1293
Practice Address - Street 1:596 W LOUISE ST
Practice Address - Street 2:
Practice Address - City:CLARKESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30523-5849
Practice Address - Country:US
Practice Address - Phone:706-754-3763
Practice Address - Fax:706-839-1293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0095243336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy