Provider Demographics
NPI:1285675066
Name:LONGENECKER PHARMACY INC.
Entity Type:Organization
Organization Name:LONGENECKER PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:J.
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:610-857-2114
Mailing Address - Street 1:108 W 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:PARKESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:19365-1259
Mailing Address - Country:US
Mailing Address - Phone:610-857-2114
Mailing Address - Fax:610-857-0179
Practice Address - Street 1:108 W 1ST AVE
Practice Address - Street 2:
Practice Address - City:PARKESBURG
Practice Address - State:PA
Practice Address - Zip Code:19365-1259
Practice Address - Country:US
Practice Address - Phone:610-857-2114
Practice Address - Fax:610-857-0179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP411519L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA19/00564088/01Medicaid
PA0752570001Medicare ID - Type Unspecified