Provider Demographics
NPI:1447200381
Name:LONG, JEREMY P (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:P
Last Name:LONG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 E LAMAR ALEXANDER PKWY
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-6206
Mailing Address - Country:US
Mailing Address - Phone:865-982-7162
Mailing Address - Fax:
Practice Address - Street 1:1612 E LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-6206
Practice Address - Country:US
Practice Address - Phone:865-982-7162
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNEMT0000026653146N00000X
TN0000023925183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Not Answered183500000XPharmacy Service ProvidersPharmacist