Provider Demographics
NPI:1326269986
Name:LONGSWORTH, LINDA ELENA
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ELENA
Last Name:LONGSWORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3645 JUANITA AVE.
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-4714
Mailing Address - Country:US
Mailing Address - Phone:850-332-6561
Mailing Address - Fax:
Practice Address - Street 1:5975 MOBILE HWY.
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32526
Practice Address - Country:US
Practice Address - Phone:850-453-3846
Practice Address - Fax:850-453-7159
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS29468183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist