MEDICARE: BRENDAN VISITHS LONG PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PH239909	MA

General Provider Information

NPI Number	:	1285222778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDAN VISITHS LONG PHARMD

Provider Business Mailing Address
First Line	:	45 VETERANS MEMORIAL DR
Second Line	:
City	:	NORTH ADAMS
State	:	MA
Zip	:	01247-2359
Country	:	US
Telephone Number	:	413-664-8712
Fax Number	:

Provider Business Practice Location Address
First Line	:	45 VETERANS MEMORIAL DR
Second Line	:
City	:	NORTH ADAMS
State	:	MA
Zip	:	01247-2359
Country	:	US
Telephone Number	:	413-664-8712
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2021
Last Update Date	:	01/09/2021

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