=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114938784
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEIGHTON PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2006
-----------------------------------------------------
Last Update Date | 09/17/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14001 HIGHWAY 43 STE 13
-----------------------------------------------------
City | RUSSELLVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35653-2848
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-331-1919
-----------------------------------------------------
Fax | 256-331-1960
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14001 HIGHWAY 43 STE 13
-----------------------------------------------------
City | RUSSELLVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35653-2848
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-331-1919
-----------------------------------------------------
Fax | 256-331-1960
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT CEO
-----------------------------------------------------
Name | RODNEY LOGAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 256-314-1434
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 112837
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------