MEDICARE: RENEE 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	19002	CO

General Provider Information

NPI Number	:	1861955064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE LONG PHARMD

Provider Business Mailing Address
First Line	:	1850 E WOODMEN RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3326
Country	:	US
Telephone Number	:	719-277-0553
Fax Number	:

Provider Business Practice Location Address
First Line	:	1850 E WOODMEN RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3326
Country	:	US
Telephone Number	:	719-277-0553
Fax Number	:

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

Provider Enumeration Date	:	04/13/2019
Last Update Date	:	04/13/2019

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Directions to “ RENEE LONG PHARMD” Practice Location

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