Provider Demographics
NPI:1396013850
Name:LONGA, GEORGE MARING
Entity Type:Individual
Prefix:PROF
First Name:GEORGE
Middle Name:MARING
Last Name:LONGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 E KANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-5804
Mailing Address - Country:US
Mailing Address - Phone:620-275-4430
Mailing Address - Fax:620-275-4703
Practice Address - Street 1:1308 E KANSAS AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5804
Practice Address - Country:US
Practice Address - Phone:620-275-4430
Practice Address - Fax:620-275-4703
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-15089183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist