Provider Demographics
NPI:1073648028
Name:LONGHORN DRUG COMPANY
Entity Type:Organization
Organization Name:LONGHORN DRUG COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-698-3737
Mailing Address - Street 1:1711 S HENDERSON BLVD
Mailing Address - Street 2:#100
Mailing Address - City:KILGORE
Mailing Address - State:TX
Mailing Address - Zip Code:75662-3563
Mailing Address - Country:US
Mailing Address - Phone:903-983-5313
Mailing Address - Fax:903-984-0923
Practice Address - Street 1:1711 S HENDERSON BLVD
Practice Address - Street 2:#100
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662-3563
Practice Address - Country:US
Practice Address - Phone:903-983-5313
Practice Address - Fax:903-984-0923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD3473332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0750190001Medicare NSC