Provider Demographics
NPI:1437871506
Name:LONG'S DRUGS OF SANDERSVILLE, GEORGIA, INC.
Entity Type:Organization
Organization Name:LONG'S DRUGS OF SANDERSVILLE, GEORGIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-641-7967
Mailing Address - Street 1:5700 GRANITE PKWY STE 425
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-6648
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2140 PEACHTREE RD NW STE 232
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1316
Practice Address - Country:US
Practice Address - Phone:404-231-4431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LONG'S DRUGS OF SANDERSVILLE, GEORGIA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy