Individual
DR. LADACIA SHARDE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
480 NORTH GLENN STREET, FAYETTEVILLE, GA 30214
(770) 461-3431
Mailing address
480 NORTH GLENN STREET, FAYETTEVILLE, GA 30214
(770) 461-3431
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
032192
GA
Other
Enumeration date
12/03/2020
Last updated
12/03/2020
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