Provider Demographics
NPI:1679866602
Name:LONG, JAMES STEPHEN
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:STEPHEN
Last Name:LONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 TATES CREEK CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-3066
Mailing Address - Country:US
Mailing Address - Phone:859-273-0222
Mailing Address - Fax:
Practice Address - Street 1:4101 TATES CREEK CENTRE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-3066
Practice Address - Country:US
Practice Address - Phone:859-273-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007103183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist