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Provider Information for 1922117282


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LOVVORN DRUG COMPANY LLC

Other Names:  
Doing Business As: 
LOVVORN DRUG COMPANY LLC

Organization Subpart: NO

NPI: 1922117282
Last Updated: 2021-11-22
Certification Date: 2021-11-22

Details

NameValue
NPI1922117282
Enumeration Date2006-08-30
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: Dr. BRANDALL S LOVVORN PHARM.D
Title: OWNER/PHARMACIST
Phone: 7705378889
Mailing Address PO BOX 603
BREMEN, GA 30110-0603
United States

Phone: 770-537-8889 | Fax:770-537-8817
 
Primary Practice Address 404 ALABAMA AVE S
BREMEN, GA 30110-2006
United States

Phone: 770-537-8889 | Fax:770-537-8817
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDGA00977479A
Other (non-Medicare)GA1150628NCPDP
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 3336L0003X - Pharmacy - Long Term Care Pharmacy
Yes 3336C0003X - Pharmacy - Community/Retail PharmacyGAPHRE008702