Provider Demographics
NPI:1871688796
Name:LONG, MARIA L (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:L
Last Name:LONG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 MAGNOLIA AVE
Mailing Address - Street 2:MODULE 4E-HEMATOLOGY/ONCOLOGY
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-3043
Mailing Address - Country:US
Mailing Address - Phone:951-353-4871
Mailing Address - Fax:951-353-5115
Practice Address - Street 1:10800 MAGNOLIA AVE
Practice Address - Street 2:MODULE 4E-HEMATOLOGY/ONCOLOGY
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3043
Practice Address - Country:US
Practice Address - Phone:951-353-4871
Practice Address - Fax:951-353-5115
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49813183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist