Provider Demographics
NPI:1871625186
Name:LONG, KIMBERLY HUDSON (RPH)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:HUDSON
Last Name:LONG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4524 BRENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-8662
Mailing Address - Country:US
Mailing Address - Phone:704-825-4524
Mailing Address - Fax:
Practice Address - Street 1:3540 E FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056-6297
Practice Address - Country:US
Practice Address - Phone:704-866-0121
Practice Address - Fax:704-866-8259
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9695183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist