Individual
AMY H LONGTINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
29 BLACK COAL DRIVE, FORT WASHAKIE, WY 82514
(307) 856-9281
Mailing address
PO BOX 1310, RIVERTON, WY 82501-0158
(307) 856-9281
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
2930
WY
Other
Enumeration date
11/09/2007
Last updated
11/09/2007
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