Active NPI
Phillip Brandon Long, RPH
- Pharmacist
- Stockton, CA
National Provider Identifier
1174155170
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 81088
- Practice address
- 2040 E Mariposa Rd
Stockton, CA 95205 - Phone
- (209) 465-4167
- NPI assigned
- Feb 7, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 81088 | CA | Primary |
Addresses
Primary practice location
2040 E Mariposa Rd
Stockton, CA 95205
Mailing address
3913 Estate Dr
Stockton, CA 95209-1570
Phone (623) 806-2959
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 81088 | CA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1581033600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1581033600000",
"number": "1174155170",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3913 ESTATE DR",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952091570",
"telephone_number": "623-806-2959"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2040 E MARIPOSA RD",
"city": "STOCKTON",
"state": "CA",
"postal_code": "95205",
"telephone_number": "209-465-4167"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LONG",
"first_name": "PHILLIP",
"middle_name": "BRANDON",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-02-07",
"last_updated": "2020-02-07",
"certification_date": "2020-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "81088",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.