Individual
DANIEL LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
630 KILBOURNE ROAD, COLUMBIA, SC 29205
(803) 254-4619
Mailing address
630 KILBOURNE RD, COLUMBIA, SC 29205
(803) 254-4619
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
25012
NC
183500000X
Pharmacist
Primary
36053
SC
Other
Enumeration date
08/30/2018
Last updated
08/30/2018
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