Provider Demographics
NPI:1578844528
Name:LONG, NATHAN THOMAS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:THOMAS
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 1:117 EMILY LN
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27596-9681
Mailing Address - Country:US
Mailing Address - Phone:405-208-1896
Mailing Address - Fax:
Practice Address - Street 1:117 EMILY LN
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27596-9681
Practice Address - Country:US
Practice Address - Phone:405-208-1896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-05
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14477183500000X
NC25459183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist