MEDICARE: CHARRON LONG PHARMD

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	PH26107	MA

General Provider Information

NPI Number	:	1770985087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARRON LONG PHARMD

Provider Business Mailing Address
First Line	:	12 TWIN OAKS RD
Second Line	:
City	:	LAKEVILLE
State	:	MA
Zip	:	02347-2117
Country	:	US
Telephone Number	:	508-813-9340
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 TWIN OAKS RD
Second Line	:
City	:	LAKEVILLE
State	:	MA
Zip	:	02347-2117
Country	:	US
Telephone Number	:	508-813-9340
Fax Number	:

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

Provider Enumeration Date	:	09/17/2014
Last Update Date	:	09/17/2014

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Directions to “ CHARRON LONG PHARMD” Practice Location

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