Provider Demographics
NPI:1033639711
Name:LONG, KAY E (RPH)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:E
Last Name:LONG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10002 MEREDITH LN SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35803-2632
Mailing Address - Country:US
Mailing Address - Phone:256-426-0923
Mailing Address - Fax:
Practice Address - Street 1:330 SUTTON RD SE
Practice Address - Street 2:
Practice Address - City:OWENS CROSS ROADS
Practice Address - State:AL
Practice Address - Zip Code:35763-9164
Practice Address - Country:US
Practice Address - Phone:256-534-4775
Practice Address - Fax:256-534-4072
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL09393183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist