Healthcare Provider Details

I. General information

NPI: 1528396785
Provider Name (Legal Business Name): DOMINICK WILLIAM LUONGO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2009
Last Update Date: 11/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1493 CAMBRIDGE ST
CAMBRIDGE MA
02139-1047
US

IV. Provider business mailing address

111 HOWARD ST
READING MA
01867-3340
US

V. Phone/Fax

Practice location:
  • Phone: 617-665-1355
  • Fax:
Mailing address:
  • Phone: 781-779-1230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number27553
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: