# EARL K LONG MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** EARL K LONG MEDICAL CENTER
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548271653
- **Authorized official:** NIKKI LEE (PHARMACY DIRECTOR)
- **Authorized official phone:** (225) 358-4826

## Contact information

- **Practice address:** 5825 AIRLINE HWY, BATON ROUGE, LA 70805-2408
- **Practice address phone:** (225) 358-4826
- **Practice address fax:** (225) 358-4827
- **Mailing address:** EKLMC-OUT PHARMACY, 5825 AIRLINE HWY, BATON ROUGE, LA 70805

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0002X | Clinic Pharmacy | — | — | — |
| 3336I0012X | Institutional Pharmacy | PHY.004380-IRX | LA | Yes |

## Other

- **Enumeration date:** 08/11/2006
- **Last updated:** 02/13/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1203831 | — | LA |
| 01 | — | 1914820 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |