Provider Demographics
NPI:1306446232
Name:LONG, ARNOLD LAMAR JR (PHARMD)
Entity type:Individual
Prefix:
First Name:ARNOLD
Middle Name:LAMAR
Last Name:LONG
Suffix:JR
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 1:2506 FLAGSTONE LN
Mailing Address - Street 2:
Mailing Address - City:BLACKSHEAR
Mailing Address - State:GA
Mailing Address - Zip Code:31516-6061
Mailing Address - Country:US
Mailing Address - Phone:912-449-6953
Mailing Address - Fax:912-287-2642
Practice Address - Street 1:2425 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31503-6337
Practice Address - Country:US
Practice Address - Phone:912-285-3939
Practice Address - Fax:912-285-5563
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA18779183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist