Healthcare Provider Details

I. General information

NPI: 1285675066
Provider Name (Legal Business Name): LONGENECKER PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 W 1ST AVE
PARKESBURG PA
19365-1259
US

IV. Provider business mailing address

108 W 1ST AVE
PARKESBURG PA
19365-1259
US

V. Phone/Fax

Practice location:
  • Phone: 610-857-2114
  • Fax: 610-857-0179
Mailing address:
  • Phone: 610-857-2114
  • Fax: 610-857-0179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPP411519L
License Number StatePA

VIII. Authorized Official

Name: MR. J. RICHARD BROWN
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 610-857-2114