Provider Demographics
NPI:1811526437
Name:DELONG, ERIK RAY (PHARM D)
Entity type:Individual
Prefix:DR
First Name:ERIK
Middle Name:RAY
Last Name:DELONG
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18546 WHITE OAK DR
Mailing Address - Street 2:
Mailing Address - City:CATLETTSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41129-8945
Mailing Address - Country:US
Mailing Address - Phone:606-465-2390
Mailing Address - Fax:
Practice Address - Street 1:600 MARION PIKE
Practice Address - Street 2:
Practice Address - City:COAL GROVE
Practice Address - State:OH
Practice Address - Zip Code:45638-2963
Practice Address - Country:US
Practice Address - Phone:740-533-2370
Practice Address - Fax:740-533-2481
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03439330183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist