CLB Pharmacy Group LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

CLB PHARMACY GROUP LLC

Doing business as

Friendly City Pharmacy on 2nd
Moons Pharmacy Inc

Practice address

717 2ND St W
Tifton, GA 31794-4201

Phone

(229) 382-3711

Fax

(229) 387-7521

NPI assigned

Oct 2, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lucas Brown

Title

Owner

Phone

(229) 563-6689

Specialties & licenses 5

Addresses

Other identifiers 3

Other names 2

• Friendly City Pharmacy on 2nd Doing business as
• MOONS PHARMACY INC Doing business as

Tax ID family

CLB Pharmacy Group LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• CLB Pharmacy Group LLC

  dba Friendly City Pharmacy on 2nd LTC

  • Long Term Care Pharmacy
  • Tifton, GA
  • NPI 1073334876
  NPD tax ID

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• CLB Pharmacy Group LLC

  dba Friendly City Pharmacy on 2nd LTC

  • Long Term Care Pharmacy
  • Tifton, GA
  • NPI 1073334876
  NPPES parent name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719532800000",
    "number": "1598858508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "717 2ND ST W",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317944201",
            "telephone_number": "229-382-3711",
            "fax_number": "229-387-7521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "717 2ND ST W",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317944201",
            "telephone_number": "229-382-3711",
            "fax_number": "229-387-7521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLB PHARMACY GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-28",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "LUCAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "229-563-6689"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE003394",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2012857",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00033855A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00033855B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Friendly City Pharmacy on 2nd",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MOONS PHARMACY INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• City Optical Inc
• Lesley A Clack, LPC
• Kara Clark
• Timothy L Clark, DO
• CLB Pharmacy Group LLC (Friendly City Pharmacy on 2nd LTC)
• Erin Elizabeth Clemmons, RD, LD
• Langston B Cleveland, MD
• Michael Clifton, CRNA
• Troy A Clifton, MD
• Amanda L Cofield, LCSW

• Community/Retail Pharmacy in Tifton, GA
• Providers in Tifton, GA by specialty
• Community/Retail Pharmacy in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.