Healthcare Provider Details

I. General information

NPI: 1356597967
Provider Name (Legal Business Name): DAVID E. LONG PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11670 ATWOOD RD
AUBURN CA
95603-9522
US

IV. Provider business mailing address

11670 ATWOOD RD
AUBURN CA
95603-9522
US

V. Phone/Fax

Practice location:
  • Phone: 530-887-2836
  • Fax: 530-887-2842
Mailing address:
  • Phone: 530-887-2836
  • Fax: 530-887-2842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number27295
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: