Provider Demographics
NPI:1790024370
Name:DO, LONG K (PHARMD)
Entity Type:Individual
Prefix:
First Name:LONG
Middle Name:K
Last Name:DO
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 1:12330 SE BUSH ST APT 14
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-3477
Mailing Address - Country:US
Mailing Address - Phone:503-758-9279
Mailing Address - Fax:
Practice Address - Street 1:14700 SE MCLOUGHLIN BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97267-1417
Practice Address - Country:US
Practice Address - Phone:503-652-4133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-02
Last Update Date:2013-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPI-0010663183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist