MEDICARE: DR. ROBERT LEON LONGE PHARM. D.

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	1835P1200X	Pharmacotherapy Pharmacist	10441	GA
2	1835P1200X	Pharmacotherapy Pharmacist	4417	SC

General Provider Information

NPI Number	:	1912900713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT LEON LONGE PHARM. D.

Provider Business Mailing Address
First Line	:	115 CASCADE DR
Second Line	:
City	:	NORTH AUGUSTA
State	:	SC
Zip	:	29841-2164
Country	:	US
Telephone Number	:	803-279-0044
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 FREEDOM WAY
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30904-6258
Country	:	US
Telephone Number	:	706-733-0188
Fax Number	:

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	03/10/2008

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