Provider Demographics
NPI:1114632338
Name:LIGHTNER, JARRED LINTON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JARRED
Middle Name:LINTON
Last Name:LIGHTNER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 RIVER NORTH CIR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-1107
Mailing Address - Country:US
Mailing Address - Phone:912-224-1522
Mailing Address - Fax:
Practice Address - Street 1:150 RIVER NORTH CIR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-1107
Practice Address - Country:US
Practice Address - Phone:912-224-1522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV23388183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist