Healthcare Provider Details

I. General information

NPI: 1104759349
Provider Name (Legal Business Name): BRADLEY DREW LONG PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2026
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 BREMO RD
RICHMOND VA
23226-1907
US

IV. Provider business mailing address

7869 WINDING ASH PL
CHESTERFIELD VA
23832-2610
US

V. Phone/Fax

Practice location:
  • Phone: 804-281-8191
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202220842
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: