Individual
JOHN LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
1612 RUTH ST, SULPHUR, LA 70663-4906
(337) 527-0033
Mailing address
120 PINE HILL LN, MONTGOMERY, TX 77356-6073
(409) 594-1171
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PST.019192
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MA.004457
—
LA
Enumeration date
12/17/2018
Last updated
12/17/2018
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