Provider Demographics
NPI:1649727538
Name:LOVVORN DRUG CO
Entity type:Organization
Organization Name:LOVVORN DRUG CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDALL
Authorized Official - Middle Name:S
Authorized Official - Last Name:LOVVORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-537-8889
Mailing Address - Street 1:404 ALABAMA AVE S
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:GA
Mailing Address - Zip Code:30110-2006
Mailing Address - Country:US
Mailing Address - Phone:770-537-8889
Mailing Address - Fax:
Practice Address - Street 1:404 ALABAMA AVE S
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:GA
Practice Address - Zip Code:30110-2006
Practice Address - Country:US
Practice Address - Phone:770-537-8889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOVVORN DRUG CO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH023270183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty