CLARKESVILLE DRUG COMPOUNDING — NPI 1013255389 (Licensed & Credentialed Suppliers — Pharmacy, Compounding Pharmacy in CLARKESVILLE, GA)

CMS-1500 Box 24J / 33a • NPI

1013255389

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

3336C0004X (CMS 58)

Licensed & Credentialed Suppliers — Pharmacy, Compounding Pharmacy

Box 32 Service Location & ZIP+4

596 W LOUISE ST, CLARKESVILLE, GA, 30523-5849

✓ 9-Digit EDI 837 ZIP+4 (30523-5849)

Practice Phone & Referral Fax

(706) 754-3763

Fax: (706) 839-1293

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1013255389 (CLARKESVILLE DRUG COMPOUNDING) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1013255389` (NPI-2 Organization / Facility)
Provider / Legal Name	CLARKESVILLE DRUG COMPOUNDING
Plain-English Specialty	Licensed & Credentialed Suppliers — Pharmacy, Compounding Pharmacy NUCC Code: `3336C0004X` (Pharmacy, Compounding Pharmacy)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	596 W LOUISE ST, CLARKESVILLE, GA, 30523-5849
Practice Telephone / Fax	Tel: (706) 754-3763 \| Fax: (706) 839-1293
Administrative Mailing Address	596 W LOUISE ST, CLARKESVILLE, GA, 30523-5849
Enumeration & Last Sync	Enumerated: 2013-01-22 \| CMS Record Updated: 2013-01-22
Authorized Official	DAVID LEDBETTER (OWNER/PHARMACIST)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

596 W LOUISE ST, CLARKESVILLE, GA, 30523-5849

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Plain-English Taxonomy & CMS Crosswalk (3336C0004X)

What Does Taxonomy Code 3336C0004X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 3336C0004X translates to:
"Licensed & Credentialed Suppliers — Pharmacy, Compounding Pharmacy"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 58 (Medical Supply Company with Pharmacist) • CMS Code A5 (Pharmacy)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Pharmacy, Compounding Pharmacy for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (CLARKESVILLE DRUG COMPOUNDING)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`3336C0004X` — Pharmacy, Compounding Pharmacy Plain English: Licensed & Credentialed Suppliers — Pharmacy, Compounding Pharmacy	State: GA \| License: `PHRE009524` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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CLARKESVILLE DRUG COMPOUNDING (NPI #1013255389)