Provider Demographics
NPI:1508993007
Name:LONG, JEFFREY LEONARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:LEONARD
Last Name:LONG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3953 CLEAR LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-9182
Mailing Address - Country:US
Mailing Address - Phone:740-454-2879
Mailing Address - Fax:740-455-4912
Practice Address - Street 1:945 BETHESDA DR
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-0801
Practice Address - Country:US
Practice Address - Phone:740-454-4044
Practice Address - Fax:740-455-4912
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-14614183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist