Provider Demographics
NPI:1598856411
Name:EVERLONG PHARMACY, L.L.P.
Entity Type:Organization
Organization Name:EVERLONG PHARMACY, L.L.P.
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANAS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:570-281-6141
Mailing Address - Street 1:99 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18407-2148
Mailing Address - Country:US
Mailing Address - Phone:570-281-6141
Mailing Address - Fax:570-281-3903
Practice Address - Street 1:99 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:PA
Practice Address - Zip Code:18407-2148
Practice Address - Country:US
Practice Address - Phone:570-281-6141
Practice Address - Fax:570-281-3903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP415529L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3975755OtherNCPDP #
PA0017548550001Medicaid
PABT6425284OtherDEA #
PA3975755OtherNCPDP #