Organization
FORT WILLIAMS PHARMACY, LLC
Active
Other names
Fort Williams Pharmacy LLC
Organization subpart
No
Provider details
NPI number
Authorized official
CHAD LIGHTSEY (OWNER)
(256) 404-6165
Entity
Organization
Contact information
Practice address
401 W FORT WILLIAMS ST, SYLACAUGA, AL 35150-2435
(256) 207-2007
(256) 207-2008
Mailing address
401 W FORT WILLIAMS ST, SYLACAUGA, AL 35150-2435
(256) 207-2007
(256) 207-2008
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
113273
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2120344
PK
—
Enumeration date
05/14/2009
Last updated
02/16/2017
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