Healthcare Provider Details

I. General information

NPI: 1235212143
Provider Name (Legal Business Name): HANZHI HELEN LONG PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39400 PASEO PADRE PKWY
FREMONT CA
94538-2310
US

IV. Provider business mailing address

39400 PASEO PADRE PKWY
FREMONT CA
94538-2310
US

V. Phone/Fax

Practice location:
  • Phone: 510-248-7008
  • Fax: 510-248-5188
Mailing address:
  • Phone: 510-248-7008
  • Fax: 510-248-5188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS34671
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number316766-1701
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberRPH51159
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number51159
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: