Provider Demographics
NPI:1770196115
Name:LONG, ALYSSA (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-2019
Mailing Address - Country:US
Mailing Address - Phone:617-254-0104
Mailing Address - Fax:
Practice Address - Street 1:465 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:ALLSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-2019
Practice Address - Country:US
Practice Address - Phone:617-254-0104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH238553183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist