Healthcare Provider Details

I. General information

NPI: 1801885041
Provider Name (Legal Business Name): LANGSTON DRUG STORE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 01/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 MAIN ST
VAN BUREN AR
72956-4555
US

IV. Provider business mailing address

124 S MADISON AVE
AURORA MO
65605-1427
US

V. Phone/Fax

Practice location:
  • Phone: 479-474-3431
  • Fax: 479-474-0106
Mailing address:
  • Phone: 417-678-4136
  • Fax: 417-678-2014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberAR20382
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberAR20382
License Number StateAR

VIII. Authorized Official

Name: RHONDA LEA MILLER-MORRISON
Title or Position: PRESIDENT
Credential:
Phone: 417-678-4136