Provider Demographics
NPI:1740387588
Name:LANGHAM DRUG STORE INC
Entity Type:Organization
Organization Name:LANGHAM DRUG STORE INC
Other - Org Name:STACEY DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARM
Authorized Official - Prefix:
Authorized Official - First Name:BURKE
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:251-943-7191
Mailing Address - Street 1:121 W LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-1966
Mailing Address - Country:US
Mailing Address - Phone:251-943-7191
Mailing Address - Fax:251-943-1221
Practice Address - Street 1:121 W LAUREL AVE
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-1966
Practice Address - Country:US
Practice Address - Phone:251-943-7191
Practice Address - Fax:251-943-1221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AL1123533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1995242OtherPK
AL100003504Medicaid