Healthcare Provider Details

I. General information

NPI: 1548271653
Provider Name (Legal Business Name): EARL K LONG MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5825 AIRLINE HWY
BATON ROUGE LA
70805-2408
US

IV. Provider business mailing address

EKLMC-OUT PHARMACY 5825 AIRLINE HWY
BATON ROUGE LA
70805
US

V. Phone/Fax

Practice location:
  • Phone: 225-358-4826
  • Fax: 225-358-4827
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License NumberPHY.004380-IRX
License Number StateLA

VIII. Authorized Official

Name: NIKKI LEE
Title or Position: PHARMACY DIRECTOR
Credential:
Phone: 225-358-4826