Provider Demographics
NPI:1205406675
Name:DIEP, LONG (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:LONG
Middle Name:
Last Name:DIEP
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 1:7100 COLUMBIA GATEWAY DR STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-2955
Mailing Address - Country:US
Mailing Address - Phone:800-336-7874
Mailing Address - Fax:
Practice Address - Street 1:7100 COLUMBIA GATEWAY DR STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2955
Practice Address - Country:US
Practice Address - Phone:800-336-7874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17265183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist