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Organization
LONG'S LAKESHORE DISCOUNT PHARMACY LLC
Active
Organization
LONG'S LAKESHORE DISCOUNT PHARMACY LLC
Active
Other names
LAKESHORE DISCOUNT PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC LONG PHARMD (OWNER/PRES)
(256) 825-0063
Entity
Organization
Contact information
Practice address
221 E SOUTH ST, DADEVILLE, AL 36853-1923
(256) 825-0063
(256) 825-5584
Mailing address
PO BOX 134, DADEVILLE, AL 36853-0134
(256) 825-0063
(256) 825-5584
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
110492
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0123721
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
100002455
—
AL
Enumeration date
12/13/2006
Last updated
01/21/2016
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