=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801885041
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LANGSTON DRUG STORE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2005
-----------------------------------------------------
Last Update Date | 01/22/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1202 MAIN ST
-----------------------------------------------------
City | VAN BUREN
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72956-4555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-474-3431
-----------------------------------------------------
Fax | 479-474-0106
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 124 S MADISON AVE
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65605-1427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-678-4136
-----------------------------------------------------
Fax | 417-678-2014
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | RHONDA LEA MILLER-MORRISON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 417-678-4136
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number | AR20382
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | AR20382
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------