Provider Demographics
NPI:1114938784
Name:LEIGHTON PHARMACY INC
Entity Type:Organization
Organization Name:LEIGHTON PHARMACY INC
Other - Org Name:RUSSELLVILLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-314-1434
Mailing Address - Street 1:14001 HIGHWAY 43
Mailing Address - Street 2:STE 13
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653-2848
Mailing Address - Country:US
Mailing Address - Phone:256-331-1919
Mailing Address - Fax:256-331-1960
Practice Address - Street 1:14001 HIGHWAY 43
Practice Address - Street 2:STE 13
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-2848
Practice Address - Country:US
Practice Address - Phone:256-331-1919
Practice Address - Fax:256-331-1960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1128373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0133974OtherNCPDP PROVIDER IDENTIFICATION NUMBER