Healthcare Provider Details

I. General information

NPI: 1447729850
Provider Name (Legal Business Name): LOUIS MORGAN DRUGS NO 4 INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 JOHNSTON ST
LONGVIEW TX
75601-3909
US

IV. Provider business mailing address

110 JOHNSTON ST
LONGVIEW TX
75601-3909
US

V. Phone/Fax

Practice location:
  • Phone: 903-758-6164
  • Fax: 903-234-9193
Mailing address:
  • Phone: 903-758-6164
  • Fax: 903-234-9193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SHAWN SAMS
Title or Position: OWNER
Credential:
Phone: 903-758-6164