Provider Demographics
NPI:1598089369
Name:LONG, ERIC B (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:B
Last Name:LONG
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 LISBON ST STE P
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-5025
Mailing Address - Country:US
Mailing Address - Phone:207-241-6589
Mailing Address - Fax:207-517-9205
Practice Address - Street 1:1155 LISBON ST STE P
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5025
Practice Address - Country:US
Practice Address - Phone:207-241-6589
Practice Address - Fax:207-517-9205
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03223600183500000X
MEPR71018183500000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist