# LEELAND PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MABLETON PHARMACY & UNIFORMS
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699272641
- **Authorized official:** JONATHAN MARQUESS (OWNER)
- **Authorized official phone:** (770) 948-3133

## Contact information

- **Practice address:** 5390 FLOYD RD SW, MABLETON, GA 30126-2216
- **Practice address phone:** (770) 948-3133
- **Practice address fax:** (770) 948-3660
- **Mailing address:** 8612 MAIN ST, WOODSTOCK, GA 30188-4829
- **Mailing address phone:** (678) 285-0760
- **Mailing address fax:** (770) 971-0315

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | PHRE005933 | GA | Yes |

## Other

- **Enumeration date:** 04/06/2018
- **Last updated:** 04/06/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 000181816A | — | GA |
| 01 | — | 2176496 | PK | — |