Healthcare Provider Details

I. General information

NPI: 1245230739
Provider Name (Legal Business Name): LEIGH MASSEY ALLEN PHARM D, BCACP, BCGP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 03/23/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 HIGHWAY 138 NW
MONROE GA
30655-7702
US

IV. Provider business mailing address

1010 ROBERTA CT. GREAT OAKS PHARMACY
BISHOP GA
30621
US

V. Phone/Fax

Practice location:
  • Phone: 770-266-0278
  • Fax: 770-207-9056
Mailing address:
  • Phone: 706-255-2357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number50010
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11574
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number022147
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: