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General NPI Number Information
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NPI Number | 1528866555
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Entity Type | Organization
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Legal Business Name | LOWER LIGHTS NORTHLAND PHARMACY
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Dates
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Enumeration Date | 03/05/2025
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Last Update Date | 10/17/2025
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Provider Practice Location Address
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Address Line | 3000 CORPORATE EXCHANGE DR
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City | COLUMBUS
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State | OH
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Zip | 43231-7689
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Country | US
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Telephone | 614-274-1455
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Fax | 614-564-9821
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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 | 614-564-9821
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Authorized Official
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Title or Position | CEO
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Name | TRACY CLOUD
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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