Provider Demographics
NPI:1902406143
Name:LONG, CYNTHIA MARIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:MARIE
Last Name:LONG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 SUMMIT RIDGE PLZ STE 1
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-9199
Mailing Address - Country:US
Mailing Address - Phone:724-542-0374
Mailing Address - Fax:724-542-0376
Practice Address - Street 1:2100 SUMMIT RIDGE PLZ STE 1
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-9199
Practice Address - Country:US
Practice Address - Phone:724-542-0374
Practice Address - Fax:724-542-0376
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP033634L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist