Provider Demographics
NPI:1053301242
Name:LONGS DRUGS OF CHARLOTTE 1 INC
Entity Type:Organization
Organization Name:LONGS DRUGS OF CHARLOTTE 1 INC
Other - Org Name:LONG'S DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:
Authorized Official - Last Name:FROST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-583-6945
Mailing Address - Street 1:PO BOX 602675
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2675
Mailing Address - Country:US
Mailing Address - Phone:704-525-3956
Mailing Address - Fax:704-525-3978
Practice Address - Street 1:3039 SOUTH BLVD STE F
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-1866
Practice Address - Country:US
Practice Address - Phone:704-525-3956
Practice Address - Fax:704-525-3978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
NC118373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2132008OtherPK