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General NPI Number Information
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NPI Number | 1194326090
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Entity Type | Individual
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Provider Name | MARIANNE MURPHY LONG
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Gender | Female
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Dates
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Enumeration Date | 11/06/2020
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Last Update Date | 11/06/2020
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Provider Practice Location Address
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Address Line | 1621 MAIN ST
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City | CHIPLEY
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State | FL
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Zip | 32428-5992
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Country | US
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Telephone | 850-638-8308
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Fax | 850-638-1379
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Provider Business Mailing Address
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Address Line | 1689 PENNY RD
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City | COTTONDALE
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State | FL
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Zip | 32431-6641
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Country | US
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Telephone | 850-239-0069
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Fax |
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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 | PS20686
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License Number State | FL
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