Provider Demographics
NPI:1780969576
Name:LASSITER, LEIGHTON LAMAR (PHARMD)
Entity type:Individual
Prefix:MR
First Name:LEIGHTON
Middle Name:LAMAR
Last Name:LASSITER
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 1:6104 BALD CYPRESS CT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-1308
Mailing Address - Country:US
Mailing Address - Phone:919-671-3997
Mailing Address - Fax:
Practice Address - Street 1:1111 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36703-4129
Practice Address - Country:US
Practice Address - Phone:334-875-4916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16315183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist