Organization
LONG LIFE PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOATH M SARSOUR PH-D (OWNER)
(414) 375-6112
Entity
Organization
Contact information
Practice address
1672 S 9TH ST UNIT D, MILWAUKEE, WI 53204-3426
(414) 326-0888
Mailing address
1255 E HICKORY CREEK CT, OAK CREEK, WI 53154-7316
(414) 375-6112
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
06/12/2019
Last updated
09/01/2023
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