MEDICARE: LUCY LONG PHARM.D

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	59760	CA

General Provider Information

NPI Number	:	1477842870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCY LONG PHARM.D

Provider Business Mailing Address
First Line	:	2789 HELMSLEY DR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95132-2915
Country	:	US
Telephone Number	:	408-254-2783
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 HAMILTON AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95125-4539
Country	:	US
Telephone Number	:	408-264-8642
Fax Number	:

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

Provider Enumeration Date	:	04/06/2011
Last Update Date	:	04/06/2011

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