Provider Demographics
NPI:1528866555
Name:LOWER LIGHTS PHARMACY
Entity type:Organization
Organization Name:LOWER LIGHTS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-274-1455
Mailing Address - Street 1:1160 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222-1352
Mailing Address - Country:US
Mailing Address - Phone:614-274-1455
Mailing Address - Fax:614-564-9821
Practice Address - Street 1:3000 CORPORATE EXCHANGE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-7689
Practice Address - Country:US
Practice Address - Phone:614-274-1455
Practice Address - Fax:614-564-9821
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOWER LIGHTS CHRISTIAN HEALTH CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy