Individual
ERIC LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
100 CHERRY ST SE, GRAND RAPIDS, MI 49503-4526
(616) 965-8200
Mailing address
315 EMMONS ST, NILES, MI 49120-2822
(269) 362-2724
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5302042671
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1173041295
—
MI
Enumeration date
03/27/2018
Last updated
03/27/2018
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