Provider Demographics
NPI:1437402559
Name:LONG, ALLEN STEPHEN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:STEPHEN
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 1:500 N GALLOWAY AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-4354
Mailing Address - Country:US
Mailing Address - Phone:972-288-4485
Mailing Address - Fax:972-329-1091
Practice Address - Street 1:500 N GALLOWAY AVE STE 2
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-4354
Practice Address - Country:US
Practice Address - Phone:972-288-4485
Practice Address - Fax:972-329-1091
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-26
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52444183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist