Provider Demographics
NPI:1841008869
Name:CRAWFORD W LONG PHARMACY INC LTC
Entity type:Organization
Organization Name:CRAWFORD W LONG PHARMACY INC LTC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:C
Authorized Official - Last Name:GURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
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:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy