Individual
ALBERT LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2510 STATE ST, EAST SAINT LOUIS, IL 62205-2323
(618) 875-5085
Mailing address
5545 ROSEMONT AVE, EAST SAINT LOUIS, IL 62204-2919
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
044511
MO
183500000X
Pharmacist
Primary
051286004
IL
Other
Enumeration date
02/09/2012
Last updated
02/09/2012
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