Provider Demographics
NPI:1780369330
Name:LONG, RYAN ALLEN
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:ALLEN
Last Name:LONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 SHAFFER HILL LN
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:PA
Mailing Address - Zip Code:17830-7205
Mailing Address - Country:US
Mailing Address - Phone:570-541-8350
Mailing Address - Fax:
Practice Address - Street 1:1100 N 4TH ST
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:PA
Practice Address - Zip Code:17801-1238
Practice Address - Country:US
Practice Address - Phone:570-286-0276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician