Individual
MARK LONGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
650 ELM STREET, PAGE, AZ 86040
(928) 645-5714
(928) 645-1286
Mailing address
650 ELM ST, PAGE, AZ 86040
(928) 645-5714
(928) 645-1286
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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