Provider Demographics
NPI:1669953345
Name:LONG, BRIAN RICHARD (PHARMD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:RICHARD
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 1:2028 N CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-7436
Mailing Address - Country:US
Mailing Address - Phone:814-443-6963
Mailing Address - Fax:
Practice Address - Street 1:2028 N CENTER AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-7436
Practice Address - Country:US
Practice Address - Phone:814-443-6963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37686183500000X
PARP454184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC37686OtherSOUTH CAROLINA STATE BOARD OF PHARMACY
PARP454184OtherPA STATE BOARD OF PHARMACY