Provider Demographics
NPI:1992097919
Name:BUI, LONG
Entity type:Individual
Prefix:
First Name:LONG
Middle Name:
Last Name:BUI
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 1:3300 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:TX
Mailing Address - Zip Code:77536-5058
Mailing Address - Country:US
Mailing Address - Phone:504-609-9791
Mailing Address - Fax:
Practice Address - Street 1:3300 CENTER ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:TX
Practice Address - Zip Code:77536-5058
Practice Address - Country:US
Practice Address - Phone:281-479-3488
Practice Address - Fax:281-476-0862
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist