Provider Demographics
NPI:1760790166
Name:LEIGHTON PHARMACY, INC
Entity Type:Organization
Organization Name:LEIGHTON PHARMACY, INC
Other - Org Name:LOGAN PHARMACY AT MOULTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:DALTON
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:256-974-1770
Mailing Address - Street 1:15190 COURT ST.
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOULTON
Mailing Address - State:AL
Mailing Address - Zip Code:35650-0000
Mailing Address - Country:US
Mailing Address - Phone:256-974-1770
Mailing Address - Fax:256-974-1709
Practice Address - Street 1:15190 COURT ST.
Practice Address - Street 2:SUITE A
Practice Address - City:MOULTON
Practice Address - State:AL
Practice Address - Zip Code:35650-1519
Practice Address - Country:US
Practice Address - Phone:256-974-1770
Practice Address - Fax:256-974-1709
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEIGHTON PHARMACY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-20
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0313050006Medicare NSC