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General NPI Number Information
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NPI Number | 1083010177
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Entity Type | Organization
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Legal Business Name | LONG'S DRUGS OF SANDERSVILLE, GEORGIA, INC.
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Dates
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Enumeration Date | 11/17/2014
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Last Update Date | 11/17/2014
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Provider Practice Location Address
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Address Line | 1524 CHURCH ST
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City | DECATUR
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State | GA
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Zip | 30030-6500
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Country | US
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Telephone | 404-270-9242
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Fax |
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Provider Business Mailing Address
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Address Line | 1524 CHURCH ST
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City | DECATUR
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State | GA
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Zip | 30030-6500
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Country | US
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Telephone | 404-270-9242
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | REBECCA GILLESPIE
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Credential |
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Telephone | 803-261-8827
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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