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General NPI Number Information
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NPI Number | 1427691211
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Entity Type | Individual
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Provider Name | RHET MITCHELL LONG PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/24/2019
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Last Update Date | 10/24/2019
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Provider Practice Location Address
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Address Line | 307 S WASHINGTON
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City | AFTON
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State | WY
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Zip | 83110
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Country | US
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Telephone | 307-885-6337
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Fax | 307-885-6339
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Provider Business Mailing Address
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Address Line | PO BOX 937
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City | AFTON
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State | WY
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Zip | 83110-0937
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Country | US
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Telephone | 307-314-5070
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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 | 4195
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License Number State | WY
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