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Individual
MARK LONGO
Active
Individual
MARK LONGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
S012588
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
151407-1701
PHARMACY LICENSE
UT
01
—
S012588
PHARMACY LICENSE
AZ
Enumeration date
06/17/2015
Last updated
06/17/2015
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