Provider Demographics
NPI:1932862521
Name:LONG, CHRIS STAFFORD
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:STAFFORD
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 1:382 ASHEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:BREVARD
Mailing Address - State:NC
Mailing Address - Zip Code:28712-4646
Mailing Address - Country:US
Mailing Address - Phone:828-877-8600
Mailing Address - Fax:
Practice Address - Street 1:382 ASHEVILLE HWY
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-4646
Practice Address - Country:US
Practice Address - Phone:828-877-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30903183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist