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General NPI Number Information
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NPI Number | 1861526675
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Entity Type | Individual
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Provider Name | JOHNNA LYNN LONG RPH
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Gender | Female
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3325 POCAHONTAS RD
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City | BAKER CITY
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State | OR
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Zip | 97814-1464
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Country | US
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Telephone | 541-523-8129
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Fax |
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Provider Business Mailing Address
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Address Line | 41020 POCAHONTAS RD
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City | BAKER CITY
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State | OR
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Zip | 97814-8101
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Country | US
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Telephone | 541-523-2931
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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 | RPH-0010571
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License Number State | OR
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