Provider Demographics
NPI:1659446458
Name:LEACH PHARMACIES, LLC
Entity Type:Organization
Organization Name:LEACH PHARMACIES, LLC
Other - Org Name:CRESTLINE PHARMACY LTC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:LEACH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:205-871-0317
Mailing Address - Street 1:60 CHURCH STREET
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213
Mailing Address - Country:US
Mailing Address - Phone:205-871-0317
Mailing Address - Fax:205-871-9756
Practice Address - Street 1:60 CHURCH ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35213-3794
Practice Address - Country:US
Practice Address - Phone:205-871-0317
Practice Address - Fax:205-871-9756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1028903336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy