| Organization Name: | CLARKESVILLE DRUG COMPOUNDING |
| NPI Number: | 1013255389 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVID LEDBETTER (OWNER/PHARMACIST) |
| Mailing Address: | 596 W Louise St Clarkesville |
| State: | GA US |
| Postal Code: | 305235849 |
| Phone Number: | 7067543763 |
| Fax Number: | 7068391293 |
| NPI Enumeration Date: | 01/22/2013 |
| NPI Last Update Date: | 01/22/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3336C0004X |
| License Number: | PHRE009524 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Pharmacy |
| Taxonomy Specialization: | Compounding Pharmacy |
| Taxonomy Definition: | A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner |