Provider Demographics
NPI:1134108731
Name:LONG, JEANNE DEE (RPH)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:DEE
Last Name:LONG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4301 68TH AVENUE CT W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4909
Mailing Address - Country:US
Mailing Address - Phone:253-732-1118
Mailing Address - Fax:253-770-5175
Practice Address - Street 1:1322 3RD ST SE STE 20
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3771
Practice Address - Country:US
Practice Address - Phone:253-697-1350
Practice Address - Fax:253-770-5175
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00018112183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist