Provider Demographics
NPI:1083817456
Name:LONG, CRAIG EUGENE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:EUGENE
Last Name:LONG
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 S CHERRY GROVE AVE
Mailing Address - Street 2:APT. 103
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-4258
Mailing Address - Country:US
Mailing Address - Phone:301-639-9937
Mailing Address - Fax:
Practice Address - Street 1:709 S CHERRY GROVE AVE
Practice Address - Street 2:APT. 103
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-4258
Practice Address - Country:US
Practice Address - Phone:301-639-9937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17179183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist