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General NPI Number Information
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NPI Number | 1134108731
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Entity Type | Individual
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Provider Name | JEANNE DEE LONG RPH
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Gender | Female
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Dates
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Enumeration Date | 01/11/2006
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Last Update Date | 06/05/2019
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Provider Practice Location Address
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Address Line | 1322 3RD ST SE STE 20
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City | PUYALLUP
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State | WA
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Zip | 98372-3771
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Country | US
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Telephone | 253-697-1350
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Fax | 253-770-5175
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Provider Business Mailing Address
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Address Line | 4301 68TH AVENUE CT W
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-4909
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Country | US
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Telephone | 253-732-1118
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Fax | 253-770-5175
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH00018112
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License Number State | WA
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