Healthcare Provider Details

I. General information

NPI: 1558303149
Provider Name (Legal Business Name): LOOKOUT MOUNTAIN COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 07/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 FANT DR
FT OGLETHORPE GA
30742-3307
US

IV. Provider business mailing address

1875 FANT DR
FT OGLETHORPE GA
30742-3307
US

V. Phone/Fax

Practice location:
  • Phone: 706-861-3387
  • Fax: 706-861-3332
Mailing address:
  • Phone: 706-861-3387
  • Fax: 706-861-3332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberPHRE006016
License Number StateGA

VIII. Authorized Official

Name: LINDA FOX
Title or Position: PHARMACY MGR
Credential: RPH
Phone: 706-861-3387