Healthcare Provider Details

I. General information

NPI: 1831429836
Provider Name (Legal Business Name): CARL OLONGO PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2010
Last Update Date: 01/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7606 S 7TH ST
PHOENIX AZ
85042-6503
US

IV. Provider business mailing address

7606 S 7TH ST
PHOENIX AZ
85042-6503
US

V. Phone/Fax

Practice location:
  • Phone: 602-243-1525
  • Fax: 602-243-0328
Mailing address:
  • Phone: 602-243-1525
  • Fax: 602-243-0328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS016319
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: