Provider Demographics
NPI:1356624837
Name:LONG, RYAN DELORAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:DELORAN
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 1:112 ROSE DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-1823
Mailing Address - Country:US
Mailing Address - Phone:865-599-8651
Mailing Address - Fax:
Practice Address - Street 1:112 ROSE DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-1823
Practice Address - Country:US
Practice Address - Phone:865-599-8651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35944183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist