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General NPI Number Information
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NPI Number | 1629014014
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Entity Type | Organization
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Legal Business Name | LONGBELLA DRUG INC
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 02/14/2017
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Provider Practice Location Address
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Address Line | 1233 HIGHWAY 10 S
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City | MOTLEY
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State | MN
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Zip | 56466-8210
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Country | US
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Telephone | 218-352-6337
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Fax | 218-352-6904
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Provider Business Mailing Address
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Address Line | 1233 HIGHWAY 10 S
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City | MOTLEY
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State | MN
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Zip | 56466-8210
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Country | US
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Telephone | 218-352-6337
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Fax | 218-352-6904
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Authorized Official
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Title or Position | RPH PRES
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Name | LANI LONGBELLAROBERTS
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Credential |
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Telephone | 218-352-6337
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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 | 261537
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License Number State | MN
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