Provider Demographics
NPI:1922381268
Name:LONG, ERIC D (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:D
Last Name:LONG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 SOLAMERE LN
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36832-5123
Mailing Address - Country:US
Mailing Address - Phone:334-774-0056
Mailing Address - Fax:
Practice Address - Street 1:5301 SUMMERVILLE RD
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-7423
Practice Address - Country:US
Practice Address - Phone:334-297-3061
Practice Address - Fax:334-297-0193
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16448183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist