Healthcare Provider Details

I. General information

NPI: 1578534616
Provider Name (Legal Business Name): WILLIAM R LONG PHARMD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 RANCHO SOLANO CT NW
ALBUQUERQUE NM
87120-5347
US

IV. Provider business mailing address

7501 RANCHO SOLANO CT NW
ALBUQUERQUE NM
87120-5347
US

V. Phone/Fax

Practice location:
  • Phone: 505-899-8770
  • Fax:
Mailing address:
  • Phone: 505-899-8770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4901
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3538
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number117090-0
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: