Provider Demographics
NPI:1558303149
Name:LOOKOUT MOUNTAIN COMMUNITY SERVICES
Entity Type:Organization
Organization Name:LOOKOUT MOUNTAIN COMMUNITY SERVICES
Other - Org Name:LMCS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MGR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:706-861-3387
Mailing Address - Street 1:1875 FANT DR
Mailing Address - Street 2:
Mailing Address - City:FT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-3307
Mailing Address - Country:US
Mailing Address - Phone:706-861-3387
Mailing Address - Fax:706-861-3332
Practice Address - Street 1:1875 FANT DR
Practice Address - Street 2:
Practice Address - City:FT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-3307
Practice Address - Country:US
Practice Address - Phone:706-861-3387
Practice Address - Fax:706-861-3332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
GAPHRE0060163336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2020206OtherPK
GA00685858AMedicaid