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General NPI Number Information
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NPI Number | 1962599159
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Entity Type | Organization
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Legal Business Name | LONG BEACH DRUGS LLC
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Dates
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Enumeration Date | 10/07/2006
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Last Update Date | 03/07/2013
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Provider Practice Location Address
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Address Line | 5107 BEATLINE RD SUITE 100
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City | LONG BEACH
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State | MS
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Zip | 39560-3871
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Country | US
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Telephone | 228-822-9868
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Fax | 228-822-2312
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Provider Business Mailing Address
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Address Line | 5107 BEATLINE RD SUITE 100
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City | LONG BEACH
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State | MS
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Zip | 39560-3871
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Country | US
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Telephone | 228-822-9868
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Fax | 228-822-2312
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Authorized Official
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Title or Position | OWNER/PHARM
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Name | LAUREL MALLEY
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Credential |
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Telephone | 228-822-9868
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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 | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 06270
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License Number State | MS
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