Healthcare Provider Details

I. General information

NPI: 1750384483
Provider Name (Legal Business Name): DANIEL S LONGYHORE PHARM.D., ED.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N ACADEMY AVE # MC24-06
DANVILLE PA
17822-9800
US

IV. Provider business mailing address

PO BOX 111; WILKES UNIVERSITY
WILKES BARRE PA
18766-0001
US

V. Phone/Fax

Practice location:
  • Phone: 570-214-1737
  • Fax:
Mailing address:
  • Phone: 570-408-4294
  • Fax: 570-408-7729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRP437853
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: