Provider Demographics
NPI:1902662620
Name:LONGBINES PHARMACY INC
Entity Type:Organization
Organization Name:LONGBINES PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP GEN MGR
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-683-4011
Mailing Address - Street 1:810 WOODROW WILSON RAY CIR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:TX
Mailing Address - Zip Code:76426-2061
Mailing Address - Country:US
Mailing Address - Phone:940-683-4011
Mailing Address - Fax:940-683-4981
Practice Address - Street 1:810 WOODROW WILSON RAY CIR
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:TX
Practice Address - Zip Code:76426-2061
Practice Address - Country:US
Practice Address - Phone:940-683-4011
Practice Address - Fax:940-683-4981
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LONGBINES PHARMACY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy