Provider Demographics
NPI:1871004986
Name:LONG, SHON MICHAEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHON
Middle Name:MICHAEL
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 1:5015 JIM GOGGANS RD
Mailing Address - Street 2:
Mailing Address - City:DORA
Mailing Address - State:AL
Mailing Address - Zip Code:35062-1808
Mailing Address - Country:US
Mailing Address - Phone:205-514-7877
Mailing Address - Fax:
Practice Address - Street 1:1600 FEDERAL DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36107-1128
Practice Address - Country:US
Practice Address - Phone:334-777-5871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20085183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL20085OtherALABAMA BOARD OF PHARMACY