Organization
CORNER CROSSING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JT LEATHERWOOD BS PHARMACY (OWNER, PIC, AO)
(256) 230-6200
Entity
Organization
Contact information
Practice address
30694 HIGHWAY 72 WEST, SUITE A, HUNTSVILLE, AL 35756
(256) 230-6200
(256) 230-6232
Mailing address
30694 HIGHWAY 72 WEST, SUITE A, HUNTSVILLE, AL 35756
(256) 230-6200
(256) 230-6232
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
114500
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
176134
—
AL
01
—
2150075
PK
—
Enumeration date
10/24/2014
Last updated
01/19/2018
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