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Organization
LONG LIFE PHARMACY LTC
Active
Organization
LONG LIFE PHARMACY LTC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOATH M SARSOUR (OWNER)
(414) 375-6112
Entity
Organization
Contact information
Practice address
1672 S 9TH ST UNIT D, MILWAUKEE, WI 53204-3426
(414) 375-6112
(414) 375-6113
Mailing address
1672 S 9TH ST UNIT D, MILWAUKEE, WI 53204-3426
(414) 375-6112
(414) 375-6113
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
NULL
Other
Enumeration date
11/27/2023
Last updated
08/13/2026
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