Healthcare Provider Details

I. General information

NPI: 1982929782
Provider Name (Legal Business Name): LEESBURG PHARMACY, INC. DBA LOOKOUT MOUNTAIN PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2010
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 SAND ROCK AVE
SANDROCK AL
35983-4327
US

IV. Provider business mailing address

PO BOX 358
LEESBURG AL
35983-0358
US

V. Phone/Fax

Practice location:
  • Phone: 256-523-5665
  • Fax: 256-523-5669
Mailing address:
  • Phone: 256-526-6337
  • Fax: 256-526-6342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number113381
License Number StateAL

VIII. Authorized Official

Name: MR. CHRIS N ST.CLAIR
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 256-526-6337