Provider Demographics
NPI:1083041040
Name:HA, LONG (RPH)
Entity Type:Individual
Prefix:
First Name:LONG
Middle Name:
Last Name:HA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N MACLEOD AVE
Mailing Address - Street 2:UNIT 1
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-1398
Mailing Address - Country:US
Mailing Address - Phone:626-673-5664
Mailing Address - Fax:
Practice Address - Street 1:3532 172ND ST NE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8758
Practice Address - Country:US
Practice Address - Phone:360-651-6194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60398135183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist