Provider Demographics
NPI:1578534616
Name:LONG, WILLIAM R (PHARMD, MBA)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:LONG
Suffix:
Gender:M
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7501 RANCHO SOLANO CT NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-5347
Mailing Address - Country:US
Mailing Address - Phone:505-899-8770
Mailing Address - Fax:
Practice Address - Street 1:7501 RANCHO SOLANO CT NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-5347
Practice Address - Country:US
Practice Address - Phone:505-899-8770
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4901183500000X
ND3538183500000X
MN117090-0183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist