MEDICARE: BETTY JANE LONG

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	RPH011227	GA
2	183500000X	Pharmacist	PS9366	FL
3	183500000X	Pharmacist	PU234	FL

General Provider Information

NPI Number	:	1285643320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETTY JANE LONG

Provider Business Mailing Address
First Line	:	3527 COUNTY LINE RD
Second Line	:
City	:	HINESVILLE
State	:	GA
Zip	:	31313-7419
Country	:	US
Telephone Number	:	912-876-3614
Fax Number	:

Provider Business Practice Location Address
First Line	:	204 BUTLER AVE
Second Line	:
City	:	MIDWAY
State	:	GA
Zip	:	31320
Country	:	US
Telephone Number	:	912-884-9255
Fax Number	:

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

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	07/08/2007

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Directions to “ BETTY JANE LONG ” Practice Location

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