Provider Demographics
NPI:1962251215
Name:CLEBURNE DRUG INC
Entity type:Organization
Organization Name:CLEBURNE DRUG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MONTE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BARRON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, MBA
Authorized Official - Phone:817-645-2415
Mailing Address - Street 1:310 N RIDGEWAY DR
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-5197
Mailing Address - Country:US
Mailing Address - Phone:817-645-2415
Mailing Address - Fax:817-645-7176
Practice Address - Street 1:310 N RIDGEWAY DR
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-5197
Practice Address - Country:US
Practice Address - Phone:817-645-2415
Practice Address - Fax:817-645-7176
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLEBURNE DRUG
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy