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General NPI Number Information
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NPI Number | 1275999724
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Entity Type | Organization
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Legal Business Name | LOWER LIGHTS PHARMACY
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Dates
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Enumeration Date | 01/13/2016
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1160 W BROAD ST
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City | COLUMBUS
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State | OH
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Zip | 43222-1352
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Country | US
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Telephone | 614-274-1455
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Fax |
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Provider Business Mailing Address
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Address Line | 1160 W BROAD ST
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City | COLUMBUS
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State | OH
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Zip | 43222-1352
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Country | US
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Telephone | 614-274-1455
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | SHELLY MAUREY
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Credential |
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Telephone | 614-274-1455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 022580300-02
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License Number State | OH
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