Healthcare Provider Details

I. General information

NPI: 1447200381
Provider Name (Legal Business Name): JEREMY P LONG PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 E LAMAR ALEXANDER PKWY
MARYVILLE TN
37804-6206
US

IV. Provider business mailing address

1612 E LAMAR ALEXANDER PKWY
MARYVILLE TN
37804-6206
US

V. Phone/Fax

Practice location:
  • Phone: 865-982-7162
  • Fax:
Mailing address:
  • Phone: 865-982-7162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberEMT0000026653
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0000023925
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: