MEDICARE: MR. LONG D VU RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03124271	OH

General Provider Information

NPI Number	:	1497037097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LONG D VU RPH

Provider Business Mailing Address
First Line	:	4401 CLEVELAND AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-1577
Country	:	US
Telephone Number	:	614-476-5063
Fax Number	:	614-476-5367

Provider Business Practice Location Address
First Line	:	4401 CLEVELAND AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-1577
Country	:	US
Telephone Number	:	614-476-5063
Fax Number	:	614-476-5367

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2011
Last Update Date	:	09/09/2011

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