Organization
J CHESTER LONG II
Active
Other names
MEDICINE SHOPPE
Organization subpart
No
Provider details
NPI number
Authorized official
J CHESTER LONG II RPH (OWNER PHARMACIST)
(765) 724-2355
Entity
Organization
Contact information
Practice address
1405 N PARK AVE, ALEXANDRIA, IN 46001-1466
(765) 724-2355
(765) 724-3495
Mailing address
1405 N PARK AVE, ALEXANDRIA, IN 46001-1466
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
60002451
IN
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100299490
—
IN
01
—
1509427
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
11/15/2006
Last updated
03/07/2023
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