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Organization
LONG'S DRUG STORE
Active
Organization
LONG'S DRUG STORE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EARSEL ROY LONG RPH (OWNER)
(662) 247-1695
Entity
Organization
Contact information
Practice address
110 E JACKSON ST, BELZONI, MS 39038-3611
(662) 247-1695
Mailing address
110 E JACKSON ST, BELZONI, MS 39038-3611
(662) 247-1695
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
E06579
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00030008
—
MS
05
—
00045124
—
MS
Enumeration date
07/03/2006
Last updated
08/22/2020
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