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General NPI Number Information
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NPI Number | 1063730844
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Entity Type | Organization
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Legal Business Name | LONGS DRUGS OF SANDERSVILLE GEORGIA INC
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Dates
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Enumeration Date | 05/04/2010
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Last Update Date | 12/18/2015
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Provider Practice Location Address
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Address Line | 1428 SCOTT BLVD
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City | DECATUR
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State | GA
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Zip | 30030-1424
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Country | US
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Telephone | 404-270-9242
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Fax | 404-270-9273
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Provider Business Mailing Address
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Address Line | PO BOX 603111
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City | CHARLOTTE
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State | NC
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Zip | 28260-3111
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Country | US
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Telephone | 803-254-5884
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Fax | 866-717-0781
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Authorized Official
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Title or Position | DIRECTOR, BUS DEV/OWNER
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Name | MARSHALL FROST
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Credential |
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Telephone | 404-583-6945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHRE010092
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License Number State | GA
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