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General NPI Number Information
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NPI Number | 1306446232
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Entity Type | Individual
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Provider Name | ARNOLD LAMAR LONG JR. PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/29/2020
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Last Update Date | 10/29/2020
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Provider Practice Location Address
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Address Line | 2425 MEMORIAL DR
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City | WAYCROSS
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State | GA
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Zip | 31503-6337
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Country | US
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Telephone | 912-285-3939
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Fax | 912-285-5563
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Provider Business Mailing Address
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Address Line | 2506 FLAGSTONE LN
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City | BLACKSHEAR
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State | GA
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Zip | 31516-6061
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Country | US
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Telephone | 912-449-6953
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Fax | 912-287-2642
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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 | 18779
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License Number State | GA
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