Provider Demographics
NPI:1528352473
Name:LONG, PEGGY A (RPH)
Entity type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:A
Last Name:LONG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9666 OLDE US 20
Mailing Address - Street 2:T-1317
Mailing Address - City:ROSSFORD
Mailing Address - State:OH
Mailing Address - Zip Code:43460-1710
Mailing Address - Country:US
Mailing Address - Phone:419-872-9126
Mailing Address - Fax:419-872-9126
Practice Address - Street 1:9666 OLDE US 20
Practice Address - Street 2:T-1317
Practice Address - City:ROSSFORD
Practice Address - State:OH
Practice Address - Zip Code:43460-1710
Practice Address - Country:US
Practice Address - Phone:419-872-9126
Practice Address - Fax:419-872-9126
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH03213194183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist