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
—
—
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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