Provider Demographics
NPI:1316565443
Name:LONG, BRIANNA (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4803 N HOBBY ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67219-3014
Mailing Address - Country:US
Mailing Address - Phone:785-527-1383
Mailing Address - Fax:
Practice Address - Street 1:1100 N SAINT FRANCIS AVE STE 200
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-2866
Practice Address - Country:US
Practice Address - Phone:785-527-1383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-109287183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist