Provider Demographics
NPI:1770982571
Name:CLUBB PHARMACY, INC
Entity type:Organization
Organization Name:CLUBB PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLUBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-845-2345
Mailing Address - Street 1:13 N MAIN ST
Mailing Address - Street 2:P.O. BOX 466
Mailing Address - City:NEW CASTLE
Mailing Address - State:KY
Mailing Address - Zip Code:40050-2538
Mailing Address - Country:US
Mailing Address - Phone:502-845-2345
Mailing Address - Fax:502-845-4567
Practice Address - Street 1:13 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:KY
Practice Address - Zip Code:40050-2538
Practice Address - Country:US
Practice Address - Phone:502-845-2345
Practice Address - Fax:502-845-4567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty