Provider Demographics
NPI:1841568649
Name:LONG, ANDREW BRAD (PHARM D)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:BRAD
Last Name:LONG
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5593 FAIRFIELD PL
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-2569
Mailing Address - Country:US
Mailing Address - Phone:251-379-9501
Mailing Address - Fax:
Practice Address - Street 1:3948 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1624
Practice Address - Country:US
Practice Address - Phone:251-345-3394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15909183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist