Provider Demographics
NPI:1659385060
Name:CRAWFORD W LONG PHARMACY INC
Entity Type:Organization
Organization Name:CRAWFORD W LONG PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:GURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:706-367-5285
Mailing Address - Street 1:86 N PUBLIC SQ
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:GA
Mailing Address - Zip Code:30549-1084
Mailing Address - Country:US
Mailing Address - Phone:706-367-5285
Mailing Address - Fax:706-367-2283
Practice Address - Street 1:86 N PUBLIC SQ
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:GA
Practice Address - Zip Code:30549-1084
Practice Address - Country:US
Practice Address - Phone:706-367-5285
Practice Address - Fax:706-367-2283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0063123336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000254958Medicaid
GA000254958Medicaid