Individual
MR. FREDERICK SAMUEL LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3312 DEVINE STREET, COLUMBIA, SC 29205-1850
(803) 748-8588
(803) 771-0277
Mailing address
3312 ELLISON ROAD, COLUMBIA, SC 29205-1850
(803) 748-8588
(803) 771-0277
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
4465
SC
Other
Enumeration date
09/13/2012
Last updated
09/13/2012
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