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Individual
LONG LE
Active
Individual
LONG LE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RP459569
PA
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
RP459569
PA
Other
Enumeration date
09/03/2025
Last updated
09/03/2025
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