Provider Demographics
NPI:1083904742
Name:LONGO, VINCENT F JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:F
Last Name:LONGO
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 WOLCOTT ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-1316
Mailing Address - Country:US
Mailing Address - Phone:203-754-3636
Mailing Address - Fax:203-755-7059
Practice Address - Street 1:1030 WOLCOTT ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-1316
Practice Address - Country:US
Practice Address - Phone:203-754-3636
Practice Address - Fax:203-755-7059
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6884183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist